Arch Hand Microsurg.  2024 Sep;29(3):196-202. 10.12790/ahm.24.0020.

The characteristics and costs of traumatic extremity amputation versus replantation at a single center in the Republic of Korea: a retrospective observational study

• Kim DH
• Jang HS
• Kwak SH
• Jung SY
• Park CI
• Lee CH
• Park K
• Lee SH

• KMID: 2558745
• DOI: http://doi.org/10.12790/ahm.24.0020

Abstract

Purpose
This study investigated the epidemiology and treatment outcomes of patients with traumatic limb amputation who visited a regional trauma center.
Methods
From November 2015 to December 2021, patients with traumatic limb amputation who visited the Regional Trauma Center at Pusan University Hospital were retrospectively studied. The injury mechanism, number of operations for accompanying injuries, hospitalization period, injury severity score, insurance classification, and medical costs were investigated using medical records. We analyzed medical costs according to the injury site and treatment method.
Results
We enrolled 57 patients who visited the hospital for traumatic limb amputation. The median patient age was 55 years, and there were 48 males and nine females. Seventeen patients underwent replantation, and 40 patients underwent amputation. Replantations were performed in 43.7% of cases of upper extremity injuries and in 12.0% of cases of lower extremity injuries. Six operations were performed per patient for replantation and three for amputation (p=0.027). In an analysis of the total medical costs submitted to the national health insurance system, replantation surgery was over twice as expensive as amputation surgery for the upper extremities (p=0.029). However, no significant cost difference was observed for lower limb amputations.
Conclusion
As a treatment for limb amputation patients, replantation requires a higher number of operations and a longer hospital stay than amputation. There was no difference in patients’ contributions to medical costs between replantation and amputation, but from the standpoint of national health insurance coverage, upper extremity injuries cost more when treated by replantation than by amputation.

Keyword

Traumatic amputation; Replantation; Surgical amputation; Health care costs

Reference

References

1. Malt RA, Mckhann C. Replantation of severed arms. JAMA. 1964; 189:716–22.

2. Yoo MC, Ahn JH, Kim BK. Replantation of severed thigh: a case report. J Korean Orthop Assoc. 1980; 15:870–3.

3. Hahn SB, Kang ES, Park BM, Kim NH, Koh YG. A clinical study of replantation of amputated limbs and digits. J Korean Orthop Assoc. 1982; 17:259–68.

4. You MC, Jo EJ, Kim IG. Replantation of amputed ankle through the distal tibial epiphysis: a case report. J Korean Orthop Assoc. 1981; 16:726–30.

5. Kim SS, Koh KI. Replantation of upper limbs and digits. J Korean Orthop Assoc. 1983; 18:1207–12.

6. Lim BY, Cheong HY, Yoo BL, Cheong SJ. A clinical study of replantation of amputated upper limbs and digits. J Korean Orthop Assoc. 1986; 21:491–8.

7. Kim HK, Cho J, Huh S, et al. Upper extremity replantation for patients with major amputation injury: follow-up results of 11 patients. Korean J Vasc Endovasc Surg. 2013; 29:10–6.

8. Chinta MS, Wilkens SC, Vlot MA, Chen NC, Eberlin KR. Secondary surgery following initial replantation/revascularization or completion amputation in the hand or digits. Plast Reconstr Surg. 2018; 142:709–16.

9. Khan N, Rashid M, Ur Rashid H, Ur Rehman Sarwar S, Khalid Choudry U, Khurshid M. Functional outcomes of secondary procedures in upper extremity replantation and revascularization. Cureus. 2019; 11:e5164.

10. Okumuş A, Cerci Ozkan A. Upper extremity replantation results in our series and review of replantation indications. Ulus Travma Acil Cerrahi Derg. 2020; 26:123–9.

11. Schmidhammer R, Nimmervoll R, Pelinka LE, et al. Bilateral lower leg replantation versus prosthetic replacement: long-term outcome of amputation after an occupational railroad accident. J Trauma. 2004; 57:824–31.

12. Wang C, Askari M, Zhang F, Lineaweaver WC. Long-term outcomes of arm replantation. Ann Plast Surg. 2020; 84(3S Suppl 2):S151–7.

13. Otto IA, Kon M, Schuurman AH, van Minnen LP. Replantation versus prosthetic fitting in traumatic arm amputations: a systematic review. PLoS One. 2015; 10:e0137729.

14. Hoogendoorn JM, van der Werken C. Grade III open tibial fractures: functional outcome and quality of life in amputees versus patients with successful reconstruction. Injury. 2001; 32:329–34.

15. Zhu H, Bao B, Zheng X. A comparison of functional outcomes and therapeutic costs: single-digit replantation versus revision amputation. Plast Reconstr Surg. 2018; 141:244e–249e.

16. Yoon AP, Mahajani T, Hutton DW, Chung KC; Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness (FRANCHISE) Group. Cost-effectiveness of finger replantation compared with revision amputation. JAMA Netw Open. 2019; 2:e1916509.

17. Sears ED, Shin R, Prosser LA, Chung KC. Economic analysis of revision amputation and replantation treatment of finger amputation injuries. Plast Reconstr Surg. 2014; 133:827–40.

18. Chen MW, Narayan D. Economics of upper extremity replantation: national and local trends. Plast Reconstr Surg. 2009; 124:2003–11.

19. Hustedt JW, Chung A, Bohl DD, Olmscheid N, Edwards S. Evaluating the effect of comorbidities on the success, risk, and cost of digital replantation. J Hand Surg Am. 2016; 41:1145–52.

20. Ben Romdhane M, Boufi M, Dona B, Hartung O, Alimi Y. Predictive factors of amputation in infrainguinal vascular trauma: a monocentric experience. Ann Vasc Surg. 2023; 93:149–56.

21. Asensio JA, Dabestani PJ, Miljkovic SS, et al. Popliteal artery injuries: less ischemic time may lead to improved outcomes. Injury. 2020; 51:2524–31.