Patterns of Surgical Care and Health Disparities of Treating Pediatric Finger Amputation Injuries in the United States

BACKGROUND: Digital amputation in children is a very strong indication for replantation, but little is known about the epidemiology and distribution of care for pediatric finger amputation injuries in the United States. The specific aims of this study were to examine trends in the surgical management of pediatric finger amputation injuries in the United States from 2000 to 2006, and to identify potential treatment disparities among various demographic groups. STUDY DESIGN: Data from the 2000, 2003, and 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database were used to identify discharge records containing at least one ICD-9-CM procedure code corresponding to digit amputation or replantation. National estimates were generated using weighted frequency calculations, and a weighted logistic regression model was used to examine the influence of various demographic factors on treatment. RESULTS: There were 1,321 weighted discharge records that satisfied our inclusion criteria. From 2000 to 2006, the rate of attempted digit replantation for pediatric finger amputation injuries has remained stable at approximately 40%. The majority of injuries were treated at nonchildren's (86%) and teaching (76%) hospitals; 52% of digit replantations were performed at hospitals with a volume of 1 to 2 digit replantations per year. We found that blacks (odds ratio [OR] 0.47), Hispanics (OR 0.37), and children without insurance (OR 0.38) were less likely to receive attempted replantation (all p < 0.05), even after controlling for potential confounding factors. CONCLUSIONS: The proportion of pediatric digit amputation injuries managed by replantation remained stable between 2000 and 2006. Whites and children with private health insurance were more likely to receive replantation than blacks, Hispanics, and children without health insurance, even after controlling for confounding factors. (J Am Coll Surg 2011;213:475-485. (C) 2011 by the American College of Surgeons)