Incidence and Characterization of Major Upper-Extremity Amputations in the National Trauma Data Bank. Issue 2 (28th June 2018)

• Record Type: Journal Article
• Authors: Inkellis, Elizabeth; Low, Eric Edison; Langhammer, Christopher; Morshed, Saam
• Is Part Of: JB & JS open access. Volume 3:Issue 2(2018)
• Publication Date: 2018-06-28
• Subjects: Orthopedic surgery -- Periodicals; Orthopedic surgery; Periodicals; 617.4705
• DOI: 10.2106/JBJS.OA.17.00038
• Languages: English
• ISSNs: 2472-7245

Abstract

Abstract : Background: There are few recent data examining the epidemiology of severe upper-extremity trauma in non-military patients. We used the National Trauma Data Bank (NTDB) to investigate the epidemiology and descriptive characteristics of upper-extremity amputations in U.S. trauma centers. Methods: We queried the 2009 to 2012 NTDB research datasets for patients undergoing major upper-extremity amputation and extracted characteristics of the patient population, injury distribution, and treating facilities. In addition, multivariable regression models were fit to identify correlates of reoperation, major in-hospital complications, duration of hospitalization, and in-hospital mortality. Results: A total of 1, 386 patients underwent a major upper-extremity amputation secondary to a trauma-related upper-extremity injury, representing 46 per 100, 000 NTDB trauma admissions from 2009 to 2012. The most frequent definitive procedures performed were amputations through the humerus (35%), forearm (30%), and hand (14%). The average duration of hospitalization for all amputees was 17 days. Thirty-one percent of patients underwent at least 1 reoperation. The rate of reoperation was significantly higher at university-associated hospitals compared with nonteaching or community hospitals (p < 0.0001). Patients who had at least 1 reoperation stayed in the hospital approximately 7 days longer than patients who did not undergo reoperation. The Injury Severity Score, hospital teaching status, concomitant neurovascular injury, and occurrence of a complication were significantly associated with reoperation. Conclusions: The present study provides an updated report on the epidemiology and characteristics of trauma-related major upper-extremity amputation in the U.S. civilian population. Additional work is necessary to assess the long-term outcomes following attempted upper-extremity salvage. The population-level data provided by the present study may help to inform the design and implementation of future studies on the optimum treatment for this survivable but life-altering injury.