title: Effect of Hospital Volume on Success of Thumb Replantation.
abstract: OBJECTIVE
  Hospital volume-outcome association has been examined for many high-risk surgical procedures. Little is known about this association for thumb replantation, a complex but essential surgical procedure to restore hand function. We aimed to determine patient and hospital characteristics that are associated with increased probability of replanted thumb survival and to examine volume-outcome association among hospitals that performed thumb replantation.
  
  
  METHODS
  We used data from 2008 to 2012 from the National Trauma Data Bank. Our sample included 773 patients who underwent thumb replantation procedures in 1 of 180 hospitals during the study period. We used patient-level logistic models to examine the association between a hospital's annual thumb replantation volume and the probability of survival for the replanted thumb.
  
  
  RESULTS
  Patients with drug/alcohol abuse record, and higher numbers of comorbid conditions had lower odds of replant success. Treatment in teaching hospitals and hospitals with a higher volume of thumb replantation increased the odds of replant survival. The risk-adjusted replantation success rate in high-volume hospitals was 12% higher than in low-volume hospitals.
  
  
  CONCLUSIONS
  Regionalization of digit replantation procedures to high-volume centers can achieve the highest rate of successful revascularization.
  
  
  METHODS
  Economic/Decision Analysis II.
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI. Electronic address: elham.mahmoudi@gmail.com.
authors.forename: Elham
authors.initials: E
authors.lastname: Mahmoudi
authors.affiliation: Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D012092:Replantation / Q000379:methods*; D013933:Thumb / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States
keywords: Volume–outcome; replantation; success rate; thumb