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  • assessment of tree based statistical learning to estimate optimal personalized treatment decision rules for traumatic Finger Amputations
    JAMA Network Open, 2020
    Co-Authors: Kelly A Speth, Alfred P. Yoon, Lu Wang, Kevin C. Chung
    Abstract:

    Importance Optimal treatment for traumatic Finger Amputation is unknown to date. Objective To use statistical learning methods to estimate evidence-based treatment assignment rules to enhance long-term functional and patient-reported outcomes in patients after traumatic Amputation of Fingers distal to the metacarpophalangeal joint. Design, Setting, and Participants This decision analytical model used data from a retrospective cohort study of 338 consenting adult patients who underwent revision Amputation or replantation at 19 centers in the United States and Asia from August 1, 2016, to April 12, 2018. Of those, data on 185 patients were included in the primary analysis. Exposures Treatment with revision Amputation or replantation. Main Outcomes and Measures Outcome measures were hand strength, dexterity, hand-related quality of life, and pain. A tree-based statistical learning method was used to derive clinical decision rules for treatment of traumatic Finger Amputation. Results Among 185 study participants (mean [SD] age, 45 [16] years; 156 [84%] male), the median number of Fingers amputated per patient was 1 (range, 1-5); 115 Amputations (62%) were distal to the proximal interphalangeal joint, and 110 (60%) affected the nondominant hand. On the basis of the tree-based statistical learning estimates, to maximize hand dexterity or to minimize patient-reported pain, replantation was found to be the best strategy. To maximize hand strength, revision Amputation was the best strategy for patients with a single-Finger Amputation but replantation was preferred for all other injury patterns. To maximize patient-reported quality of life, revision Amputation was the best approach for patients with dominant hand injuries, and replantation was the best strategy for patients with nondominant hand injuries. Conclusions and Relevance The findings suggest that the approach to treating traumatic Finger Amputations varies based on the patient’s injury characteristics and functional needs.

  • reliability and validity of upper extremity patient reported outcome measures in assessing traumatic Finger Amputation management
    Plastic and Reconstructive Surgery, 2020
    Co-Authors: Alfred P. Yoon, Surinder Kaur, Chinghan Chou, Kevin C. Chung
    Abstract:

    Background This study investigates the psychometric properties of patient-reported outcome instruments for assessing outcomes in postsurgical traumatic digit Amputation patients. The authors hypothesize that the Michigan Hand Outcomes Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are the most valid and reliable instruments. Methods The authors studied traumatic digit Amputation patients as part of the Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness (FRANCHISE) study initiated by The Plastic Surgery Foundation. The MHQ, DASH questionnaire, Patient-Reported Outcomes Measurement Information System (PROMIS), and 36-Item Short-Form Health Survey were used to assess patients at least 1 year postoperatively. Internal consistency was measured by Cronbach's alpha and criterion validity with Pearson correlation coefficient (r). Construct validity was tested with four predefined hypotheses. Discriminant validity was analyzed by receiver operating characteristic curves. Results One hundred sixty-eight replantation and 74 revision Amputation patients met the inclusion criteria. All instruments demonstrated fair to good internal consistency in both cohorts (0.7 0.60) in both cohorts. The 36-Item Short-Form Health Survey had moderate to weak correlation with the remaining instruments, and its mental component had poor discriminant validity (area under the curve, 0.64 to 0.67). The MHQ, DASH questionnaire, and PROMIS demonstrated good construct validity confirming 75 to 100 percent of predefined hypotheses, whereas the 36-Item Short-Form Health Survey confirmed only 25 percent. Conclusions The authors recommend using the Michigan Hand Outcomes Questionnaire or the Disabilities of the Arm, Shoulder and Hand questionnaire when assessing patient-reported outcomes in digit Amputation patients based on good internal consistency and validity. The Patient-Reported Outcomes Measurement Information System has fair validity and reliability but should be an adjunct instrument. The 36-Item Short-Form Health Survey should not be used as a primary assessment tool, but as an adjunct to assess overall quality of life.

  • Cost-effectiveness of Finger Replantation Compared With Revision Amputation
    JAMA network open, 2019
    Co-Authors: Alfred P. Yoon, Kevin C. Chung, Tanvi Mahajani, David W. Hutton, Satisfaction Amputation Challenges In Assessing Impairment
    Abstract:

    Importance Traumatic digit Amputation is the most common type of Amputation injury, but the cost-effectiveness of its treatments is unknown. Objective To assess the cost-effectiveness of Finger replantation compared with revision Amputation. Design, Setting, and Participants This economic evaluation was conducted using data from the Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness (FRANCHISE), a retrospective, multicenter cohort study at 19 centers in the United States and Asia that enrolled participants from August 1, 2016, to April 12, 2018. Model variables were based on the FRANCHISE database, Centers for Medicare & Medicaid Services, and published literature. A total of 257 participants with unilateral traumatic Finger Amputations treated with revision Amputation or replantation distal to the metacarpophalangeal joint and at least 1 year of follow-up after treatment were included in the analysis. Exposures Revision Amputation or replantation of traumatic Finger Amputations. Main Outcomes and Measures Main outcome measures were quality-adjusted life-years (QALYs), total costs (in US dollars), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness. Results Of the 257 study participants (mean [SD] age, 46.7 [15.9] years; 221 [86.0%] male), 178 underwent Finger replantation and 79 underwent revision Amputation. In a base case of a 46.7-year-old patient, replantation was associated with QALY gains of 0.30 (95% credible interval [CrI], −0.72 to 1.38) for single-Finger (not thumb), 0.39 (95% CrI, −1.00 to 1.90) for thumb, 1.69 (95% CrI, −0.13 to 3.76) for multiFinger excluding thumb, and 1.27 (95% CrI, −2.21 to 5.04) for multiFinger including thumb injury patterns. Corresponding ICERs for replantation compared with revision Amputation were $99 157 per QALY for single-Finger (not thumb), $66 278 per QALY for thumb, $18 388 per QALY for multiFinger excluding thumb, and $21 528 per QALY for multiFinger including thumb injury patterns. Sensitivity analysis revealed that age at time of injury, life expectancy, postinjury utility, wages, and time off work for recovery had the strongest associations with cost-effectiveness. Probabilistic sensitivity analysis revealed the following chances of replantation being cost-effective: 47% in single-Finger (not thumb), 52% in thumb, 78% in multiFinger excluding thumb, and 64% in multiFinger including thumb injury patterns. Conclusions and Relevance With proper patient selection, replantation of all Finger Amputation patterns, whether single-Finger or multiFinger injuries, may be cost-effective compared with revision Amputation. MultiFinger replantations had a higher probability of being cost-effective than single-Finger replantations. Cost-effectiveness may depend on injury pattern and patient factors and thus appears to be important for consideration when patients and surgeons are deciding whether to replant or amputate.

  • patient reported and functional outcomes after revision Amputation and replantation of digit Amputations the franchise multicenter international retrospective cohort study
    JAMA Surgery, 2019
    Co-Authors: Kevin C. Chung, Alfred P. Yoon, Melissa J Shauver, Lu Wang, Sunitha Malay, Surinder Kaur
    Abstract:

    Importance Optimal treatment for traumatic digit Amputation is unknown. Objective To compare long-term patient-reported and functional outcomes between patients treated with revision Amputation or replantation for digit Amputations. Design, Setting, and Participants Retrospective cohort study at 19 centers in the United States and Asia. Participants were 338 individuals 18 years or older with traumatic digit Amputations with at least 1 year of follow-up after treatment. Participants were enrolled from August 1, 2016, to April 12, 2018. Exposures Revision Amputation or replantation of traumatic digit Amputations. Main Outcomes and Measures The primary outcome was the Michigan Hand Outcomes Questionnaire (MHQ) score. Secondary outcomes were the 36-Item Short Form Health Survey (SF-36), Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity module scores and functional outcomes. Results Among 338 patients who met all inclusion criteria, the mean (SD) age was 48.3 (16.4) years, and 85.0% were male. Adjusted aggregate comparison of patient-reported outcomes (PROs) between patients with revision Amputation and replantation revealed significantly better outcomes in the replantation cohort measured by the MHQ (5.93; 95% CI, 1.03-10.82;P = .02), DASH (−4.29; 95% CI, −8.45 to −0.12;P = .04), and PROMIS (3.44; 95% CI, 0.60 to 6.28;P = .02) scores. In subgroup analyses, DASH scores were significantly lower (6 vs 9,P = .05), indicating less disability and pain, and PROMIS scores higher (78 vs 75,P = .04) after replantation. Patients with 3 or more digits amputated (including thumb) had significantly better PROs after replantation than those managed with revision Amputation (22 vs 42,P = .03 for DASH and 61 vs 36,P = .01 for PROMIS). Patients who underwent replantation after 3 or more digits amputated (excluding thumb) had higher MHQ scores, which did not reach statistical significance (69 vs 65,P = .06). Revision Amputation in the subgroup with single-Finger Amputation distal to the proximal interphalangeal joint resulted in better 2-point discrimination (6 vs 8 mm,P = .05). Compared with revision Amputation, replantation resulted in better 9-hole peg test times in the subgroup with 3 or more digits amputated (including thumb) (46 vs 81 seconds,P = .001), better Semmes-Weinstein monofilament test in the subgroup with 3 or more digits amputated (excluding thumb) (3 vs 21 g,P = .008), and better 3-point pinch test in the subgroup with 2 digits amputated (excluding thumb) (6.7 vs 5.6 kg,P = .03). Conclusions and Relevance When technically feasible, replantation is recommended in 3 or more digits amputated and in single-Finger Amputation (excluding thumb) distal to the proximal interphalangeal joint because it achieved better PROs, with long-term functional benefit. Thumb replantation is still recommended for its integral role in opposition.

  • cross cultural variation in preference for replantation or revision Amputation societal and surgeon views
    Injury-international Journal of The Care of The Injured, 2016
    Co-Authors: Brianna L Maroukis, Melissa J Shauver, Takanobu Nishizuka, Hitoshi Hirata, Kevin C. Chung
    Abstract:

    Treatment decisions after an injury like Finger Amputation are made based on injury and patient factors. However, decisions can also be influenced by provider and patient preferences. We compared hand surgeon and societal preferences and attitudes regarding Finger Amputation treatment in Japan and the US. We performed a cross-sectional survey with subjects derived from large tertiary care academic institutions in the US and Japan. We secured 100% participation of American hand surgeon members of the Finger Replantation and Amputation Multicenter Study and presenting hand surgeons at the 32nd Annual meeting of the Central Japanese Society for Surgery of the Hand. Societal preferences were gathered from volunteers at the 2 universities in the US and Japan. There were no significant differences in estimations of function, sensation, or appearance after replantation; American and Japanese societal participants preferred replantation compared to surgeons, although this was more pronounced in Japan. The Japanese society displayed more negative attitudes toward Finger amputees than did Japanese surgeons. American respondents anticipated more public stigmatisation of amputees than did American surgeons. Societal preference for replantation was not caused by inflated expectations of outcomes after replantation. Japanese societal preference was likely driven by negative views of Finger amputees. American society noted no decrease in physical health after Amputation, but did note a quality of life decrease attributed to public stigmatisation. Japanese society and surgeons had a stronger preference for replantation than American society and surgeons, possibly attributed to cultural differences.

Tomaz Maver - One of the best experts on this subject based on the ideXlab platform.

Zala Kuret - One of the best experts on this subject based on the ideXlab platform.

Gaj Vidmar - One of the best experts on this subject based on the ideXlab platform.

Melissa J Shauver - One of the best experts on this subject based on the ideXlab platform.

  • patient reported and functional outcomes after revision Amputation and replantation of digit Amputations the franchise multicenter international retrospective cohort study
    JAMA Surgery, 2019
    Co-Authors: Kevin C. Chung, Alfred P. Yoon, Melissa J Shauver, Lu Wang, Sunitha Malay, Surinder Kaur
    Abstract:

    Importance Optimal treatment for traumatic digit Amputation is unknown. Objective To compare long-term patient-reported and functional outcomes between patients treated with revision Amputation or replantation for digit Amputations. Design, Setting, and Participants Retrospective cohort study at 19 centers in the United States and Asia. Participants were 338 individuals 18 years or older with traumatic digit Amputations with at least 1 year of follow-up after treatment. Participants were enrolled from August 1, 2016, to April 12, 2018. Exposures Revision Amputation or replantation of traumatic digit Amputations. Main Outcomes and Measures The primary outcome was the Michigan Hand Outcomes Questionnaire (MHQ) score. Secondary outcomes were the 36-Item Short Form Health Survey (SF-36), Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity module scores and functional outcomes. Results Among 338 patients who met all inclusion criteria, the mean (SD) age was 48.3 (16.4) years, and 85.0% were male. Adjusted aggregate comparison of patient-reported outcomes (PROs) between patients with revision Amputation and replantation revealed significantly better outcomes in the replantation cohort measured by the MHQ (5.93; 95% CI, 1.03-10.82;P = .02), DASH (−4.29; 95% CI, −8.45 to −0.12;P = .04), and PROMIS (3.44; 95% CI, 0.60 to 6.28;P = .02) scores. In subgroup analyses, DASH scores were significantly lower (6 vs 9,P = .05), indicating less disability and pain, and PROMIS scores higher (78 vs 75,P = .04) after replantation. Patients with 3 or more digits amputated (including thumb) had significantly better PROs after replantation than those managed with revision Amputation (22 vs 42,P = .03 for DASH and 61 vs 36,P = .01 for PROMIS). Patients who underwent replantation after 3 or more digits amputated (excluding thumb) had higher MHQ scores, which did not reach statistical significance (69 vs 65,P = .06). Revision Amputation in the subgroup with single-Finger Amputation distal to the proximal interphalangeal joint resulted in better 2-point discrimination (6 vs 8 mm,P = .05). Compared with revision Amputation, replantation resulted in better 9-hole peg test times in the subgroup with 3 or more digits amputated (including thumb) (46 vs 81 seconds,P = .001), better Semmes-Weinstein monofilament test in the subgroup with 3 or more digits amputated (excluding thumb) (3 vs 21 g,P = .008), and better 3-point pinch test in the subgroup with 2 digits amputated (excluding thumb) (6.7 vs 5.6 kg,P = .03). Conclusions and Relevance When technically feasible, replantation is recommended in 3 or more digits amputated and in single-Finger Amputation (excluding thumb) distal to the proximal interphalangeal joint because it achieved better PROs, with long-term functional benefit. Thumb replantation is still recommended for its integral role in opposition.

  • traumatic Finger Amputation treatment preference among hand surgeons in the united states and japan
    Plastic and Reconstructive Surgery, 2016
    Co-Authors: Melissa J Shauver, Takanobu Nishizuka, Hitoshi Hirata, Kevin C. Chung
    Abstract:

    Purpose Large geographic differences in utilization of a procedure draw into question its appropriate use. In Japan, replantation is commonly conducted for even very distal Finger Amputations. In the US, revision Amputation is far more common. There has been no detailed investigation into the drivers of these differences.

  • cross cultural variation in preference for replantation or revision Amputation societal and surgeon views
    Injury-international Journal of The Care of The Injured, 2016
    Co-Authors: Brianna L Maroukis, Melissa J Shauver, Takanobu Nishizuka, Hitoshi Hirata, Kevin C. Chung
    Abstract:

    Treatment decisions after an injury like Finger Amputation are made based on injury and patient factors. However, decisions can also be influenced by provider and patient preferences. We compared hand surgeon and societal preferences and attitudes regarding Finger Amputation treatment in Japan and the US. We performed a cross-sectional survey with subjects derived from large tertiary care academic institutions in the US and Japan. We secured 100% participation of American hand surgeon members of the Finger Replantation and Amputation Multicenter Study and presenting hand surgeons at the 32nd Annual meeting of the Central Japanese Society for Surgery of the Hand. Societal preferences were gathered from volunteers at the 2 universities in the US and Japan. There were no significant differences in estimations of function, sensation, or appearance after replantation; American and Japanese societal participants preferred replantation compared to surgeons, although this was more pronounced in Japan. The Japanese society displayed more negative attitudes toward Finger amputees than did Japanese surgeons. American respondents anticipated more public stigmatisation of amputees than did American surgeons. Societal preference for replantation was not caused by inflated expectations of outcomes after replantation. Japanese societal preference was likely driven by negative views of Finger amputees. American society noted no decrease in physical health after Amputation, but did note a quality of life decrease attributed to public stigmatisation. Japanese society and surgeons had a stronger preference for replantation than American society and surgeons, possibly attributed to cultural differences.

  • a comparative study of attitudes regarding digit replantation in the united states and japan
    Journal of Hand Surgery (European Volume), 2015
    Co-Authors: Takanobu Nishizuka, Kevin C. Chung, Lin Zhong, Melissa J Shauver, Hitoshi Hirata
    Abstract:

    Purpose To compare the societal preferences for Finger replantation between the United States (US) and Japan and to investigate factors influencing the preferences. Methods A sample of the general population without current hand disease or condition was recruited via flyers posted in public areas of 2 major academic centers in the US and Japan. The recruited subjects completed a survey presenting Finger Amputation scenarios and various factors that may affect treatment decisions. We performed univariate analysis using treatment preference as the outcome and all other factors as possible predictors using the chi-square test. Results Most respondents in both countries preferred replantation and there was no significant difference between the US and Japan. Treatment preference was significantly associated with the importance of appearance, recovery time, and the chance of survival of the replanted digit. There was no association between treatment preference and attitudes regarding body integrity or estimate of stigma toward Finger amputees. Japanese participants agreed more with statements of body integrity, and Japanese respondents rated appearance, sensation, and chance of survival of the replant as more important than did American participants. Conclusions Patient preference is not driving the decrease in Finger replantations in the US. The general public in both countries prefer replantation over wound closure for digit Amputations. Type of study/level of evidence Economic and decision analysis III.