Study explores impact of decentralization of digital replantation

SEATTLE — Research presented here found both decreased numbers of high volume surgeons and hospitals performing digital replantation and lower rates of successful digital replantation in the United States during a 15-year period, leading them to call for the establishment of national centers of excellence to improve success rates.

“We believe the establishment of national centers of excellence for digital replantation and a discussion on proper referral may increase overall replantation success in the United States,” Joshua William Hustedt, MD, MHS, stated during presentation at the American Society for Surgery of the Hand Annual Meeting.

Hustedt and his colleagues used the National Inpatient Sample Database to evaluate data on 15,821 digital replantations from 101,693 amputation injuries. The benchmarks for high volume replantation centers were greater than 20 per year and for high volume surgeons it was greater than five replantations per year.

Significant declines were noted in the rate of successful replantation (74.5% to 65.7%) as well as quantity of high volume surgeons (14.4% to 2.6%) and centers (15.5% to 8.9%) throughout the study.

“When greater than 15% of replant procedures nationally were performed at high volume hospitals, there was a significant increase in overall national success rates,” Hustedt said.

High volume surgeons at high volume centers were 2.5 times more likely to complete a successful replantation than a low volume surgeon at a low volume hospital.

Compared to those with lower volume, higher success rates were observed in both higher volume surgeons (79.3% to 72.2%) and centers (77.1% to 70.9%). These trends continued in high volume surgeons at high volume centers (success rate: 92%) as opposed to low volume surgeons at low volume centers (72.1%). – by Christian Ingram


Hustedt JW, et al. Paper #2. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 10-12, 2015; Seattle.

Disclosure: Hustedt reports no relevant financial disclosures.

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