PMID- 26672590
OWN - NLM
STAT- MEDLINE
DCOM- 20160418
LR  - 20151217
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 81
IP  - 11
DP  - 2015 Nov
TI  - Transfers for Hand Surgery Correlate with Increased Reoperations for 
      Complications.
PG  - 1177-81
AB  - Wrist, hand, and finger trauma are the most common nonlethal injuries presenting 
      to emergency departments. In Tennessee, lack of available hand care, particularly 
      the need for emergency hand surgery, could be detrimental to patient outcomes. 
      This is a retrospective outcomes study of patients requiring revisional hand 
      surgeries. Patients were identified and stratified by distance to Vanderbilt 
      University Medical Center (VUMC) to determine if patient complications increase 
      with distance from VUMC. As distance of patient county of residence from VUMC 
      increased, per cent of patients without a complication decreased (P < 0.0001). 
      Counties without 24/7 comprehensive hand call also showed a distance difference 
      in complication rates. Per capita income and mean household income showed no 
      effect on complications. Distance from treating facility is correlated with 
      patient outcomes and need for revisional surgery. Limitations in care 
      availability in Tennessee are not specific to hand surgery. If the trend toward 
      poorer outcomes as a result of limited local care availability extends to other 
      specialties, this could have implications regarding health-care realignment. 
      Specifically for patients with complex injuries or conditions that will be 
      referred to centralized flagship hospitals, increases in patient travel may limit 
      positive outcomes.
FAU - Rooks, Hunter J
AU  - Rooks HJ
AD  - College of Medicine, University of Tennessee Health Science Center, Memphis, 
      Tennessee, USA.
FAU - Anthony, Joshua R
AU  - Anthony JR
FAU - Sexton, Kevin W
AU  - Sexton KW
FAU - Marshall, Andre P
AU  - Marshall AP
FAU - Guillamondegui, Oscar D
AU  - Guillamondegui OD
FAU - Ehrenfeld, Jesse M
AU  - Ehrenfeld JM
FAU - Shack, R Bruce
AU  - Shack RB
FAU - Thayer, Wesley P
AU  - Thayer WP
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Emergency Medical Services/supply & distribution
MH  - Hand Injuries/*surgery
MH  - Health Services Accessibility/*trends
MH  - Humans
MH  - Income
MH  - Postoperative Complications/*surgery
MH  - Reoperation
MH  - Residence Characteristics
MH  - Retrospective Studies
MH  - Tennessee
EDAT- 2015/12/18 06:00
MHDA- 2016/04/19 06:00
CRDT- 2015/12/18 06:00
PHST- 2015/12/18 06:00 [entrez]
PHST- 2015/12/18 06:00 [pubmed]
PHST- 2016/04/19 06:00 [medline]
PST - ppublish
SO  - Am Surg. 2015 Nov;81(11):1177-81.