Cost Analysis of Devascularized Digit Injury Management
Document Type
Event
Location
LSUHSC-NO Lions Building
Start Date
11-4-2025 3:30 PM
End Date
11-4-2025 5:00 PM
Description
Purpose: This study aims to determine how injury patterns, patient-specific variables, and treatment pathways influence the costs and cost-effectiveness of managing devascularized digits.
Methods: Patients with traumatically devascularized digits between 2019-2024 were queried through our institution’s medical record system using ICD-10 codes. Data included demographics, injury characteristics, outcomes, and unadjusted patient charges. Michigan Hand Outcomes Questionnaire (MHQ) scores were estimated through meta-analysis. Data was analyzed with comparative/regression statistics and incremental cost-effectiveness ratios (ICER).
Results: Our analysis included 102 patients, of which 17 had replantation, 23 had revascularization, and 62 had revision amputations. Mean charges were $100,856 (SD $34,083) for replantation, $92,925 (SD $42,022) for revascularization, and $39,830 (SD $67,402) for revision amputations. Failed replants were $6,699 less than successes ($98,491 vs. $105,191; P=.72), while failed revascularizations were $60,579 more than successes ($132,268 vs. $81,996; P=.02). Hospital length of stay was the most significant association for cost, with each day costing $15,633 (P<.001, R2= 0.77). Leech therapy increased average hospital stay by 6 days for revascularization (P=.02) and 3 days for replantation (P=.02). Higher Elixhauser Comorbidity Scores showed a significant positive association with charges (P=.04, R2=0.26). The estimated MHQ ICER for replants was $13,974 per MHQ point, with the most cost-effective replant scenario being single non-thumb distal replants ($11,203) and the least cost-effective being single non-thumb crush/avulsion replants ($29,970). Revascularizations had an estimated ICER of $7,793 per MHQ point, with the most cost-effective being multi-digit non-thumb revascularizations (-$1,412) and least cost-effective being multi-digit non-thumb crush/avulsion revascularizations ($27,856).
Conclusion: There are many factors influencing costs in digit salvage and revision. Failed revascularization was significantly more expensive than successes, but replantation demonstrated no significant difference. The cost-effectiveness of salvage versus revision varied by procedure and injury classification, with multi-digit revascularization being the most cost-effective. Reducing hospital stays and providing cost-effective procedures should be prioritized to optimize cost-efficiency.
Recommended Citation
Delahoussaye, William, "Cost Analysis of Devascularized Digit Injury Management" (2025). Medicine Research Day. 21.
https://digitalscholar.lsuhsc.edu/mrd/2025/cv/21
Cost Analysis of Devascularized Digit Injury Management
LSUHSC-NO Lions Building
Purpose: This study aims to determine how injury patterns, patient-specific variables, and treatment pathways influence the costs and cost-effectiveness of managing devascularized digits.
Methods: Patients with traumatically devascularized digits between 2019-2024 were queried through our institution’s medical record system using ICD-10 codes. Data included demographics, injury characteristics, outcomes, and unadjusted patient charges. Michigan Hand Outcomes Questionnaire (MHQ) scores were estimated through meta-analysis. Data was analyzed with comparative/regression statistics and incremental cost-effectiveness ratios (ICER).
Results: Our analysis included 102 patients, of which 17 had replantation, 23 had revascularization, and 62 had revision amputations. Mean charges were $100,856 (SD $34,083) for replantation, $92,925 (SD $42,022) for revascularization, and $39,830 (SD $67,402) for revision amputations. Failed replants were $6,699 less than successes ($98,491 vs. $105,191; P=.72), while failed revascularizations were $60,579 more than successes ($132,268 vs. $81,996; P=.02). Hospital length of stay was the most significant association for cost, with each day costing $15,633 (P<.001, R2= 0.77). Leech therapy increased average hospital stay by 6 days for revascularization (P=.02) and 3 days for replantation (P=.02). Higher Elixhauser Comorbidity Scores showed a significant positive association with charges (P=.04, R2=0.26). The estimated MHQ ICER for replants was $13,974 per MHQ point, with the most cost-effective replant scenario being single non-thumb distal replants ($11,203) and the least cost-effective being single non-thumb crush/avulsion replants ($29,970). Revascularizations had an estimated ICER of $7,793 per MHQ point, with the most cost-effective being multi-digit non-thumb revascularizations (-$1,412) and least cost-effective being multi-digit non-thumb crush/avulsion revascularizations ($27,856).
Conclusion: There are many factors influencing costs in digit salvage and revision. Failed revascularization was significantly more expensive than successes, but replantation demonstrated no significant difference. The cost-effectiveness of salvage versus revision varied by procedure and injury classification, with multi-digit revascularization being the most cost-effective. Reducing hospital stays and providing cost-effective procedures should be prioritized to optimize cost-efficiency.