National Population Study of the Effect of Structure and Process on Outcomes of Digit Replantation.

Background Surgeon experience, hospital volume and teaching hospital status may play a role in success of digit replantation. This study aims to analyse factors that influence digit replantation success rates. Methods We examined patients with traumatic digit amputations between 2000 and 2015 from the National Health Insurance Research Database (NHIRD) of Taiwan that comprises data of over 99% of its population. We measured the number of traumatic digit amputations and success rate of replantation. Chi-square and ANOVA tests were used for descriptive statistics. Regression models were built to analyze the association among patient, surgeon, and hospital characteristics, and replant success. Results We identified 13,416 digit replantation patients using the eligibility criteria. The overall replantation failure rate was significantly higher in medium and high-volume hospitals (low-volume: 11 %, medium-volume: 17 % and high-volume: 15%, p value Conclusion Teaching hospitals had greater odds of replantation failure owing to being high volume centers and attempting more replantations. However, the effect of residents performing the replantation during their training should be considered. Teaching units are mandatory for resident training; however, a balance should be established to provide training but with sufficient supervision to achieve optimal replant success. A national protocol to triage digit amputation cases to high volume centers with experienced microsurgeons will help improve the replantation success rate.