Download PDF
J Hand Microsurg 2022; 14(02): 147-152
DOI: 10.1055/s-0040-1714152
Original Article

Preoperative Deficiency Anemia in Digital Replantation: A Marker of Disparities, Increased Length of Stay, and Hospital Cost

Fouad Chouairi
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
2   Yale University School of Medicine, New Haven, Connecticut, United States
,
Michael R. Mercier
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
2   Yale University School of Medicine, New Haven, Connecticut, United States
,
Michael Alperovich
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
2   Yale University School of Medicine, New Haven, Connecticut, United States
,
James Clune
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
2   Yale University School of Medicine, New Haven, Connecticut, United States
,
Adnan Prsic
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
2   Yale University School of Medicine, New Haven, Connecticut, United States
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Introduction The effects of preoperative anemia have been shown to be an independent risk factor associated with poor outcomes in both cardiac and noncardiac surgery. Socioeconomic status and race have also been linked to poor outcomes in a variety of conditions. This study was designed to study iron deficiency anemia as a marker of health disparities, length of stay and hospital cost in digital replantation.

Materials and Methods Digit replantations performed between 2008 and 2014 were reviewed from the National Inpatient Sample (NIS) database using the ICD-9-CM procedure codes 84.21 and 84.22. Patients with more than one code or with an upper arm (83.24) or hand replantation (84.23) code were excluded. Extracted variables included age, race, comorbidities, hospital type, hospital region, insurance payer type, and median household income quartile. Digit replantations were separated into patients with and without deficiency anemia. Demographics, comorbidities, and access to care were compared between cohorts by chi-squared and t-tests. Multivariate regressions were utilized to assess the effects of anemia on total cost and length of stay. The regression controlled for demographics, region, income, insurance, hospital type, and comorbidities. Beta coefficient was calculated for length of stay and hospital cost. The regression controlled for significant age, race, region, and comorbidities in addition to the above variables.

Results In the studied patient population of those without anemia, 59.5% were Caucasian, and in patients with anemia, 46.7% were Caucasian (p < 0.001). Whereas in the in the studied patient population of those without anemia, 6.7% were Black, and in patients with anemia, 15.7% were Black (p < 0.001). Median household income, payer information, length of stay and total cost of hospitalization had statistically significant differences. Using regression and β-coefficient, the effect of anemia on length of stay and cost was also significant (p < 0.001). Regression controlled for age, race, region and comorbidities, with the β-coefficient for effect on cost 37327.18 and on length of stay 3.96.

Conclusion These data show that deficiency anemias are associated with a significant increase in length and total cost of stay in patients undergoing digital replantation. Additionally, a larger percentage of patients undergoing digital replantations and who have deficiency anemia belong to the lowest income quartile. Our findings present an important finding for public health prevention and resource allocation. Future studies could focus on clinical intervention with iron supplementation at the time of digital replantation.

Keywords

hand surgery - NIS - anemia - digit replantation


Publication History

Article published online:
28 June 2020

© 2020. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Conn JM, Annest JL, Ryan GW, Budnitz DS. Non-work-related finger amputations in the United States, 2001-2002. Ann Emerg Med 2005; 45 (06) 630-635
    CrossrefPubMedGoogle Scholar
  • 2 Sorock GS, Lombardi DA, Hauser RB, Eisen EA, Herrick RF, Mittleman MA. Acute traumatic occupational hand injuries: type, location, and severity. J Occup Environ Med 2002; 44 (04) 345-351
    CrossrefPubMedGoogle Scholar
  • 3 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 (04) 827-840
    CrossrefPubMedGoogle Scholar
  • 4 Boulas HJ. Amputations of the fingers and hand: indications for replantation. J Am Acad Orthop Surg 1998; 6 (02) 100-105
    CrossrefPubMedGoogle Scholar
  • 5 Hannah SD. Psychosocial issues after a traumatic hand injury: facilitating adjustment. J Hand Ther 2011; 24 (02) 95-102
    CrossrefPubMedGoogle Scholar
  • 6 Pet MA, Ko JH. Indications for replantation and revascularization in the hand. Hand Clin 2019; 35 (02) 119-130
    CrossrefPubMedGoogle Scholar
  • 7 Ono S, Chung KC. Efficiency in digital and hand replantation. Clin Plast Surg 2019; 46 (03) 359-370
    CrossrefPubMedGoogle Scholar
  • 8 Chung KC, Yoon AP, Malay S, Shauver MJ, Wang L, Kaur S. FRANCHISE Group. Patient-reported and functional outcomes after revision amputation and replantation of digit amputations: the FRANCHISE Multicenter International Retrospective Cohort Study. JAMA Surg 2019; 154 (07) 637-646
    CrossrefPubMedGoogle Scholar
  • 9 Tessler O, Bartow MJ, Tremblay-Champagne MP. et al Long-term health-related quality of life outcomes in digital replantation versus revision amputation. J Reconstr Microsurg 2017; 33 (06) 446-451
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 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 (12) 1145-1152
    CrossrefPubMedGoogle Scholar
  • 11 Kulier A, Levin J, Moser R. et al Investigators of the Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 2007; 116 (05) 471-479
    CrossrefPubMedGoogle Scholar
  • 12 Shanbhag SP, Solano MA, Botros MA, Khanuja HS. Treating preoperative anemia to improve patient outcomes after orthopaedic surgery. J Am Acad Orthop Surg 2019; 27 (24) e1077-e1085
    CrossrefPubMedGoogle Scholar
  • 13 Muñoz M, Gómez-Ramírez S, Campos A, Ruiz J, Liumbruno GM. Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus 2015; 13 (03) 370-379
    CrossrefPubMedGoogle Scholar
  • 14 Theusinger OM, Leyvraz PF, Schanz U, Seifert B, Spahn DR. Treatment of iron deficiency anemia in orthopedic surgery with intravenous iron: efficacy and limits: a prospective study. Anesthesiology 2007; 107 (06) 923-927
    CrossrefPubMedGoogle Scholar
  • 15 Niibayashi H, Tamura K, Fujiwara M, Ikeda N. Survival factors in digital replantation: significance of postoperative anaemia. J Hand Surg [Br] 2000; 25 (05) 512-515
    CrossrefPubMedGoogle Scholar
  • 16 Squitieri L, Reichert H, Kim HM, Steggerda J, Chung KC. Patterns of surgical care and health disparities of treating pediatric finger amputation injuries in the United States. J Am Coll Surg 2011; 213 (04) 475-485
    CrossrefPubMedGoogle Scholar
  • 17 Cho HE, Zhong L, Kotsis SV, Chung KC. Finger Replantation Optimization Study (FRONT): update on national trends. J Hand Surg Am 2018; 43 (10) 903-912.e1
    CrossrefPubMedGoogle Scholar
  • 18 Long C, Suarez PA, Hernandez-Boussard T, Curtin C. Disparities in Access to Care Following Traumatic Digit Amputation. Hand (N Y) 2019; Doi: DOI: 10.1177/1558944718824700.
    CrossrefPubMedGoogle Scholar
  • 19 Taheri PA, Butz DA, Greenfield LJ. Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg 2000; 191 (02) 123-130
    CrossrefPubMedGoogle Scholar
  • 20 Moore L, Cisse B, Batomen Kuimi BL. et al Impact of socio-economic status on hospital length of stay following injury: a multicenter cohort study. BMC Health Serv Res 2015; 15: 285
    CrossrefPubMedGoogle Scholar
  • 21 Taheri PA, Butz D, Griffes LC, Morlock DR, Greenfield LJ. Physician impact on the total cost of care. Ann Surg 2000; 231 (03) 432-435
    CrossrefPubMedGoogle Scholar
  • 22 Gandhi SJ, Hagans I, Nathan K, Hunter K, Roy S. Prevalence, comorbidity and investigation of anemia in the primary care office. J Clin Med Res 2017; 9 (12) 970-980
    CrossrefPubMedGoogle Scholar
  • 23 Lunn JN, Elwood PC. Anaemia and surgery. BMJ 1970; 3 (57/14) 71-73
    CrossrefPubMedGoogle Scholar
  • 24 Miles LF, Kunz SA, Na LH, Braat S, Burbury K, Story DA. Postoperative outcomes following cardiac surgery in non-anaemic iron-replete and iron-deficient patients - an exploratory study. Anaesthesia 2018; 73 (04) 450-458
    CrossrefPubMedGoogle Scholar
  • 25 White MC, Longstaff L, Lai PS. Effect of pre-operative anaemia on post-operative complications in low-resource settings. World J Surg 2017; 41 (03) 644-649
    CrossrefPubMedGoogle Scholar
  • 26 Rashkin MC, Bosken C, Baughman RP. Oxygen delivery in critically ill patients. Relationship to blood lactate and survival. Chest 1985; 87 (05) 580-584
    CrossrefPubMedGoogle Scholar
  • 27 Allen LA, Anstrom KJ, Horton JR, Shaw LK, Eisenstein EL, Felker GM. Relationship between anemia and health care costs in heart failure. J Card Fail 2009; 15 (10) 843-849
    CrossrefPubMedGoogle Scholar
  • 28 Feng S, Greenberg J, Moloo H, Thavorn K, McIsaac DI. Hospital cost associated with anemia in elective colorectal surgery: a historical cohort study. Can J Anaesth 2019; 66 (08) 877-885
    CrossrefPubMedGoogle Scholar
  • 29 Chouairi F, Mercier MR, Alperovich M. Interpreting complications from database research: limitations of the national inpatient sample. Plast Reconstr Surg 2019; 144 (05) 943e
    CrossrefPubMedGoogle Scholar
  • 30 Chung KC, Kowalski CP, Walters MR. Finger replantation in the United States: rates and resource use from the 1996 Healthcare Cost and Utilization Project. J Hand Surg Am 2000; 25 (06) 1038-1042
    CrossrefPubMedGoogle Scholar
  • 31 Friedrich JB, Poppler LH, Mack CD, Rivara FP, Levin LS, Klein MB. Epidemiology of upper extremity replantation surgery in the United States. J Hand Surg Am 2011; 36 (11) 1835-1840
    CrossrefPubMedGoogle Scholar