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. 2018 Apr 24;3(2):e0038.
doi: 10.2106/JBJS.OA.17.00038. eCollection 2018 Jun 28.

Incidence and Characterization of Major Upper-Extremity Amputations in the National Trauma Data Bank

Elizabeth Inkellis  1 , Eric Edison Low  2 , Christopher Langhammer  1 , Saam Morshed  1   3
Affiliations

Incidence and Characterization of Major Upper-Extremity Amputations in the National Trauma Data Bank

Elizabeth Inkellis et al. JB JS Open Access. .

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.

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Figures

Fig. 1
Fig. 1
Chart illustrating the patient-selection process.
Fig. 2
Fig. 2
Diagram illustrating the amputation levels described in Table II.
See this image and copyright information in PMC

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