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Incidence, Timing, and Risk Factors for Secondary Revision After Primary Revision of Traumatic Digit Amputations.

Publication ,  Journal Article
Harris, AP; Goodman, AD; Gil, JA; Sobel, AD; Li, NY; Raducha, JE; Baird, GL; Katarincic, JA
Published in: J Hand Surg Am
November 2018

PURPOSE: Primary revision amputation is the most common treatment method for traumatic digit amputations in the United States. Few studies have reported secondary revision rates after primary revision amputation. The primary aim of our study was to identify risk factors for secondary revision within 1 year of the index procedure. Secondarily, we describe the incidence and timing of complications requiring secondary revision. METHODS: Our institution's emergency department (ED) database was reviewed for traumatic digit amputations over a 6-year period. Patients were reviewed for demographic characteristics, comorbidities, site of treatment (ED versus operating room), and complications requiring secondary revision. Conditional Cox Proportional Hazard regression was used to model hazard of revision within 1 year of index procedure relative to site of initial management, mechanism of injury, injury characteristics, and patient demographics. RESULTS: Five hundred and thirty-seven patients with 677 digits were managed with primary revision amputation. Five hundred and eighty-six digits (86.6%) were revised in the ED, and 91 (13.4%) in the operating room. Ninety-one digits required secondary revision, including 83 within 1 year. No increased risk of secondary revision amputation within 1 year of the index procedure was observed for patients treated in the ED compared with the operating room. Relative to crush injuries, bite and sharp laceration amputations had 4.8 times and 2.6 times increased risk of secondary revision, respectively. The index finger had a 5.3-fold increased risk of revision with the thumb as the reference digit. Work-related injuries had a 1.9-fold increased risk of secondary revision compared with non-work-related injuries. CONCLUSIONS: No evidence was found indicating that traumatic digit amputations primarily revised in the ED had an increased risk of secondary revision. Patients may be counseled on the risk of secondary procedures based on the mechanism of injury, injury characteristics and demographics, as well as the timing of complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

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Published In

J Hand Surg Am

DOI

EISSN

1531-6564

Publication Date

November 2018

Volume

43

Issue

11

Start / End Page

1040.e1 / 1040.e11

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Factors
  • Rhode Island
  • Retrospective Studies
  • Replantation
  • Reoperation
  • Postoperative Complications
  • Orthopedics
  • Occupational Injuries
  • Middle Aged
 

Citation

APA
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ICMJE
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Harris, A. P., Goodman, A. D., Gil, J. A., Sobel, A. D., Li, N. Y., Raducha, J. E., … Katarincic, J. A. (2018). Incidence, Timing, and Risk Factors for Secondary Revision After Primary Revision of Traumatic Digit Amputations. J Hand Surg Am, 43(11), 1040.e1-1040.e11. https://doi.org/10.1016/j.jhsa.2018.03.028
Harris, Andrew P., Avi D. Goodman, Joseph A. Gil, Andrew D. Sobel, Neill Y. Li, Jeremy E. Raducha, Grayson L. Baird, and Julia A. Katarincic. “Incidence, Timing, and Risk Factors for Secondary Revision After Primary Revision of Traumatic Digit Amputations.J Hand Surg Am 43, no. 11 (November 2018): 1040.e1-1040.e11. https://doi.org/10.1016/j.jhsa.2018.03.028.
Harris AP, Goodman AD, Gil JA, Sobel AD, Li NY, Raducha JE, et al. Incidence, Timing, and Risk Factors for Secondary Revision After Primary Revision of Traumatic Digit Amputations. J Hand Surg Am. 2018 Nov;43(11):1040.e1-1040.e11.
Harris, Andrew P., et al. “Incidence, Timing, and Risk Factors for Secondary Revision After Primary Revision of Traumatic Digit Amputations.J Hand Surg Am, vol. 43, no. 11, Nov. 2018, pp. 1040.e1-1040.e11. Pubmed, doi:10.1016/j.jhsa.2018.03.028.
Harris AP, Goodman AD, Gil JA, Sobel AD, Li NY, Raducha JE, Baird GL, Katarincic JA. Incidence, Timing, and Risk Factors for Secondary Revision After Primary Revision of Traumatic Digit Amputations. J Hand Surg Am. 2018 Nov;43(11):1040.e1-1040.e11.

Published In

J Hand Surg Am

DOI

EISSN

1531-6564

Publication Date

November 2018

Volume

43

Issue

11

Start / End Page

1040.e1 / 1040.e11

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Factors
  • Rhode Island
  • Retrospective Studies
  • Replantation
  • Reoperation
  • Postoperative Complications
  • Orthopedics
  • Occupational Injuries
  • Middle Aged