RESUMO
BACKGROUND: Digit amputations are relatively simple and are often performed in the setting of trauma or infection. However, it is not uncommon for digit amputations to undergo secondary revision due to complications or patient dissatisfaction. Identifying factors associated with secondary revision may alter treatment strategy. We hypothesize that the secondary revision rate is affected by digit, initial level of amputation, and comorbidities. METHODS: A retrospective chart review was conducted on patients undergoing digit amputations in operating rooms at our institution from 2011 to 2017. Secondary revision amputations were defined as a separate return to the operating room following initial surgical amputation, excluding emergency room amputations. Patient demographics, comorbidities, level of amputation, and complications were collected. RESULTS: In all, 278 patients were included with a total of 386 digit amputations and mean follow-up of 2.6 months. Three hundred twenty-six primary digit amputations were performed in 236 patients (group A). Sixty digits were secondarily revised in 42 patients (group B). The secondary revision rate was 17.8% for patients and 15.5% for digits. Patients with heart disease and diabetes mellitus were associated with secondary revision, with wound complications being the leading indication overall (73.8%). Medicare covered 52.4% of patients in group B versus 30.1% in group A (P = .005). CONCLUSION: Risk factors for secondary revision include Medicare insurance, comorbidities, previous digit amputations, and initial amputation of either the index finger or the distal phalanx. These data may serve as a prediction model to aid surgical decision-making by identifying patients at risk of secondary revision amputation.
RESUMO
STUDY DESIGN: Systematic review. OBJECTIVE: To assess the impact of hospital volume on postoperative outcomes in spine surgery. SUMMARY OF BACKGROUND DATA: Several strategies have recently been proposed to optimize provider outcomes, such as regionalization to higher volume centers and setting volume benchmarks. MATERIALS AND METHODS: We performed a systematic review examining the association between hospital volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior/posterior cervical fusions, anterior/posterior lumbar fusions, laminectomies, discectomies, spinal deformity surgeries, and surgery for spinal malignancies. We searched the Pubmed, OVID MEDLINE (1966-2018), Google Scholar, and Web of Science (1900-2018) databases in January 2018 using the search criteria ("Hospital volume" OR "volume" OR "volume-outcome" OR "volume outcome") AND ("spine" OR "spine surgery" OR "lumbar" OR "cervical" OR "decompression" OR "deformity" OR "fusions"). There were no restrictions placed on study design, publication date, or language. The studies were evaluated with respect to the quality of methodology as outlined by the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: Twelve studies were included in the review. Studies were variable in defining hospital volume thresholds. Higher hospital volume was associated with statistically significant lower risks of postoperative complications, a shorter length of stay, lower cost of hospital stay, and a lower risk of readmissions and reoperations/revisions. CONCLUSIONS: Our findings suggest a trend toward better outcomes for higher volume hospitals; however, further study needs to be carried out to define objective volume thresholds for specific spine surgeries for hospitals to use as a marker of proficiency.