Evaluating the National Hand Trauma Center Network from 2010 to 2022: Digit and Thumb Replant Activity and Trends.

PURPOSE: This study investigates the finger and thumb replant activity in the American Society for Surgery of the Hand/American College of Surgeons National Hand Trauma Center Network (NHTCN). Additionally, it evaluates trends in finger replantation and revision amputation by age, trends in replant success, and identifies demographic and socioeconomic factors associated with finger replantation.

METHODS: A retrospective cohort study was conducted using the PearlDiver Mariner database, querying finger amputation diagnoses and subsequent replant and revision amputation surgeries with International Classification of Diseases, Ninth/Tenth and Current Procedural Terminology codes. Cases were stratified by age (0-17, 18-65, >65 years) and location, including states and metropolitan statistical areas (MSA) with NHTCN centers. Socioeconomic data were derived from US Census data. Replant success was defined as replantation without subsequent revision amputation.

RESULTS: A total of 30,732 revision amputations and 1,202 replants of amputated digits were included. From 2010 to 2022, replants decreased (β: -0.50, P < .001) by 60.1% overall and by 57.1% in ages 0-17 (β: -0.94, P = .002). Nine centers averaged two or more finger replants per 100 amputations and 43 MSA averaged less than one replant per year. MSA replant rate correlated positively with NHTCN center count (r = 0.26; P = .040) yet state replant rate correlated negatively center count (r = -0.40; P = .018). Replant rate increased with mean family income (r = 0.39; P = .021). Replant success declined from 89.7% in 2010 to 75.0% in 2022 (β: -0.01, P = .004).

CONCLUSIONS: Digit replantation continued to decline nationally, particularly in ages <65. There was a wide discrepancy between a few highly active and many under-active centers in the NHTCN. The replantation rate was lower in states with more centers, reflecting a decentralization of replantable fingers in the setting of higher amputation volumes. Greater age and lower mean family income are associated with lower replantation rates.

LEVEL OF EVIDENCE: Retrospective cohort study, level II.