Trends in Digit Replantation and Revision Amputation in the United States From 2009 to 2019

Purpose: Digit amputations can be managed either with replantation or revision amputation. The advent and refinement of microsurgical techniques allowed for the reliable success of replantation. Despite this, rates of digit replantation have been decreasing over the past several decades. A paucity of data exists on recent trends. The authors hypothesize that rates of both replantation and revision amputation will continue to downtrend.

Methods: IBM Watson Health Marketscan Commercial Claims and Encounters and Medicare Supplemental databases were queried for digit replantation and revision amputations from 2009 to 2019. National volumes and incidences were estimated by combining these data with population data from the United States Census Bureau Public Use Microdata Sample. Linear regression was performed to evaluate trends. Subgroup analysis was performed for both volume and incidence to elucidate the role of age, sex, and geographical location.

Results: Between 2009 and 2019, there were an estimated 2,207 digit replantations and 53,810 digit revision amputations. The volume of replantations decreased by 42.2%, and the incidence of replantations decreased by 46.3%. The volume of revision amputations decreased by 16.2%, and the incidence of revision amputations decreased by 22.2%. Men were the majority of both groups, accounting for 75.6% of replantations and 83.6% of amputations. The replantation-to-amputation ratio decreased from 0.057 to 0.039 (-31.0%).

Conclusions: Both digit replantations and revision amputations continued to decline over the decade from 2009 to 2019. The downtrend in replantations outpaced the downtrend in revision amputations, resulting in a decreased replantation-to-amputation ratio.

Type of study/level of evidence: Therapeutic IV.