Journal List > J Korean Soc Surg Hand > v.21(3) > 1106527

Lee, Kim, Jo, Choi, Shin, and Kim: Characteristics of Inpatients with Distal Phalangeal Injuries: Predictors of Long Term Hospitalization

Abstract

Purpose:

Distal phalangeal injury is one of the most common hand injuries. Distal phalanx is very small area, but in the patients who injure in this area, hospiltalization is often necessary. Some of the patients need the long hospital stay for three or more weeks. Assessment of trends of the injuries may help in enhancing patient education and designing the management plan. We analyzed the characteristics of inpatients with distal phalangeal injuries and the predictors of long-term hospitalization.

Methods:

A retrospective review of inpatients with distal phalangeal injuries was performed consecutively from June 2008 to July 2015. Patient demographics and outcomes were compared with chi-squared analysis and Student's t-test. Using multivariate regression analysis, predictors of long-term hospitalization were identified.

Results:

Five hundred and twelve patients were investigated. The rate of long-term hospitalization was 21.9%. Multivariate logistic regression model revealed that diabetes mellitus, operation time of three or more hours, amputation injury, injury sustained at an industrial place, complication, distant flaps, and replantation were significant risk factors of long-term hospitalization.

Conclusion:

This analysis will help evaluate the possibility of long-term hospitalization and manage patients with distal phalangeal injuries.

REFERENCES

1. Chau N, Gauchard GC, Siegfried C, et al. Relationships of job, age, and life conditions with the causes and severity of occupational injuries in construction workers. Int Arch Occup Environ Health. 2004; 77:60–6.
crossref
2. Michael WN, Elvin GZ, Nicole ZS, Theresa AH. Nail and fingertip reconstruction. Neligan PC. Plastic surgery. Elsevier;2013. p. 130–3.
3. Al-Dawood KM. Non-fatal occupational injuries admitted to hospitals among general organization for social insurance workers in Al-khobar city, saudi arabia: experience of one year. J Family Community Med. 2000; 7:35–42.
4. Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg Am. 1990; 15:148–54.
crossref
5. Roh SY, Shim WC, Lee KJ, Lee DC, Kim JS, Yang JW. ShortTerm Strength Deficit Following Zone 1 Replantations. Arch Plast Surg. 2015; 42:614–8.
crossref
6. Khan NA, Quan H, Bugar JM, Lemaire JB, Brant R, Ghali WA. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med. 2006; 21:177–80.
crossref
7. Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect. 2006; 63:255–62.
crossref
8. Falanga V. Wound healing and its impairment in the diabetic foot. Lancet. 2005; 366:1736–43.
crossref
9. Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009; 91:1621–9.
crossref
10. Akyurek M, Safak T, Kecik A. Fingertip replantation at or distal to the nail base: use of the technique of artery-only anastomosis. Ann Plast Surg. 2001; 46:605–12.
11. Moore L, Cisse B, Batomen Kuimi BL, et al. Impact of socio-economic status on hospital length of stay following injury: a multicenter cohort study. BMC Health Serv Res. 2015; 15:285.
crossref

Table 1.
The investigated variables
Classification Variables
Patient demographics Sex, age, smoking, diabetes mellitus, hypertension
Injury profiles Cause, type of injury, location, number, injury place, injury time, terminal tendon injury, distal phalangeal fracture, nail structure injury, time to hospital
Perioperative details Laboratory values (white blood cell, hemoglobin, C-reactive protein, hemoglobin A1c), anesthesia, operation time, reconstructive techniques, postoperative complications
Others Occupation, education status
Table 2.
Postoperative complications
Complication No. (%)
Total 68 (13.3)
Partial necrosis of flap or skin graft 29 (42.6)
Total necrosis of flap or skin graft 10 (14.7)
Wound dehiscence 17 (25.0)
Surgical site infection 12 (17.6)
Table 3.
Frequency of complications
Number Complication
Type of injury
Crushing 196 18 (9.2)
Laceration 136 9 (6.6)
Avulsion 32 2 (6.3)
Amputation 148 39 (26.4)
Primary surgery
Skin grafts 65 7 (10.8)
Local flaps 382 40 (10.5)
Distant flaps 43 7 (16.3)
Replantation 22 14 (63.6)

Values are presented as number (%).

Table 4.
Characteristics of inpatients with distal phalangeal Injuries
Demographics Short term hospitalization (under 3 wk) Long term Hospitalization (3 wk or more) p-value
No. of patients 400 112
Sex
Male 309 (78.6) 84 (21.4) 0.982
Female 91 (76.5) 28 (23.5) 0.974
Age
<20 44 (91.7) 4 (8.3) 0.997
20-40 112 (80.0) 28 (20.0) 0.994
40-60 192 (76.7) 65 (25.3) 0.134
>60 52 (77.6) 15 (22.4) 0.981
Hand
Left 195 (79.3) 51 (20.74) 0.407
Right 205 (77.1) 61 (22.9) 0.395
No. of fingers
One 341 (79.9) 86 (20.1) 0.914
Two 34 (65.4) 18 (34.6) 0.334
Three 16 (72.7) 6 (27.3) 0.882
Four 9 (81.8) 2 (18.2) 0.992
Location
Thumb 71 (82.6) 15 (17.4) 0.993
Index 132 (74.6) 45 (25.4) 0.52
Middle 88 (74.6) 30 (25.4) 0.617
Ring 65 (86.7) 10 (13.3) 0.997
Little 44 (78.6) 12 (21.4) 0.988
Type of injury
Crushing 166 (84.7) 30 (15.3) 0.952
Laceration 118 (86.8) 18 (13.2) 0.975
Avulsion 26 (81.3) 6 (18.7) 0.924
Amputation 90 (60.8) 58 (39.2) <0.001a)
Distal phalangeal fracture 0.045a)
No 290 (80.8) 69 (19.2)
Yes 110 (71.9) 43 (28.1)
Terminal tendon injury
No 248 (72.3) 95 (27.7) 0.172
Yes 152 (89.9) 17 (10.1)
Nail structure injury 0.128
No 301 (80.9) 71 (19.1)
Yes 99 (70.7) 41 (29.3)
Diabetes mellitus 0.007a)
No 381 (79.4) 99 (20.6)
Yes 19 (59.4) 13 (40.6)
Hypertension 0.251
No 352 (77.2) 104 (22.8)
Yes 48 (85.7) 8 (14.3)
Smoking 0.041a)
No 237 (78.5) 65 (21.5)
Yes 163 (77.6) 47 (22.4)
Anesthesia
Local 354 (78.3) 98 (21.7) 0.879
Regional 31 (77.5) 9 (22.5) 0.348
General 15 (75.0) 5 (25.0) 0.047a)
Primary surgery
Skin grafts 55 (84.6) 10 (15.4) 0.912
Local flaps 327 (85.6) 55 (14.4) 0.934
Distant flaps 9 (20.9) 34 (79.1) <0.001a)
Replantation 9 (40.9) 13 (59.1) <0.001a)
Operation time
<1 hr 236 (89.7) 27 (10.3) 0.995
1-3 hr 147 (68.4) 68 (31.6) 0.073
>3 hr 17 (50.0) 17 (50.0) <0.001a)
Wound complication <0.001a)
No 375 (84.5) 69 (15.5)
Yes 25 (36.8) 43 (63.2)
Partial necrosis 5 (17.2) 24 (82.8)
Total necrosis 0 10 (100)
Dehiscence 13 (76.5) 4 (23.5)
Surgical site infection 7 (58.3) 5 (41.7)
Education 0.879
No/Obligation 195 (78.3) 54 (21.7)
High 205 (77.9) 58 (22.1)
Injury place
Farm 74 (77.9) 21 (22.1) 0.892
Industrial place 164 (68.3) 76 (31.7) 0.031a)
Residence 162 (91.5) 15 (8.5) 0.927
Injury time
0:00-6:00 37 (94.9) 2 (5.1) 0.998
6:00-12:00 113 (80.1) 28 (19.9) 0.917
12:00-18:00 144 (71.3) 58 (28.7) 0.162
18:00-24:00 106 (81.5) 24 (18.5) 0.934
Time to hospital
<0.5 hr 263 (76.0) 83 (24.0) 0.617
0.5-2 hr 108 (81.2) 25 (18.8) 0.945
>2 hr 29 (87.9) 4 (12.1) 0.981

Values are presented as number (%).

a) Significant difference, p<0.05.

Table 5.
The associated factors of long-term hospitalization on multivariate regression
Variable Odds ratio 95% Confidence interval p-value
Amputation injury 3.494 1.382-8.830 0.008a)
Distal phalangeal fracture 1.094 0.523-2.287 0.811
Diabetes 4.410 1.195-6.276 0.026a)
Uncontrolled (hemoglobin A1c >10.0%) 1.559 0.002-8.691 0.543
Smoking 1.200 0.546-2.636 0.650
General anesthesia 0.477 0.133-1.716 0.257
Primary surgery
Distant flap 19.609 7.611-50.518 <0.001a)
Replantation 6.045 2.079-17.582 0.001a)
Operation for >3 hr 5.264 1.617-7.134 0.006a)
Wound complication (necrosis of skin graft of flap) 7.297 3.266-16.300 <0.001a)
Injury at industrial place 2.969 1.556-5.663 0.001a)

Hosmer-Lemeshow statistic, 0.833.

a) Significant difference, p<0.05.

TOOLS
Similar articles