Grants We Funded

Abstract
Finger replantation was first successfully accomplished more than 40 years ago. Since that time, this
procedure has become commonplace in hand and reconstructive surgery. The surgeon must weigh many
characteristics of the patient and the severed digit to determine whether replantation can be accomplished
with reasonable anticipated outcomes. Some situations arise in which replantation is only marginally
indicated. Success is measured not only in survival, but also function of the replanted digit. The specific aim of this project is to perform a cost-utility analysis to assess various types of digit replantation procedures and to compare replantation surgery to revision amputation, specifically considering differences in mechanism of injury, level of amputation, and the age of the patient. First we will perform a systematic review of outcomes of finger replantation and revision amputation to determine rates of complications and anticipated impairment. Second, we will design a decision-analysis model based on methodology proposed by The Panel on Cost Effectiveness in Health and Medicine to assess the societal preferences from groups
of informed subjects for the various surgical options. The data from the systematic review and decision
analysis will be used to conduct a cost-utility analysis of the various treatment options. Cost will include
direct medical costs and indirect costs of time away from work. Utility is determined by preferences for
health states from different perspectives associated with each treatment. The utilities will be translated to
the common measure of quality adjusted life years (QALYs). The data obtained from this study will help guide surgeons in the difficult process of treating patients with
digit amputations in situations where replantation is not clearly indicated. Because of rising healthcare costs
and lack of access to replantation surgery in the United States, it is critical that evidence-based data are
presented to guide resource allocation and encourage use of treatments that improve patient outcomes.
More economic analysis is needed in Plastic Surgery to define the value of our treatment for the nation.

Biography
Erika D. Sears, MD, MS, serves as an Assistant Professor in the Section of Plastic Surgery at the University of Michigan Health System. At VA Ann Arbor Health Care System, she is a Staff Physician in Plastic Surgery and a research investigator in the VA Center for Clinical Management Research. Dr. Sears received her Bachelors of Science in Biomedical Engineering from Northwestern University and Doctor of Medicine from the University of Michigan Medical School. She completed the Integrated Plastic Surgery Residency and Hand Surgery Fellowship at the University of Michigan. She also received additional research training in health services research as a fellow of the Robert Wood Johnson Clinical Scholars Program where she earned a Master of Science degree in health services research from the University of Michigan Rackham Graduate School. Dr. Sears has published 32 peer-reviewed manuscripts and 15 book chapters. Her research interests include the study of practice variation in hand and plastic surgery and its influence on patient outcomes and resource utilization. Her research is dedicated to finding strategies to improve the efficiency and value of surgical care. With grant support from the PSF, Dr. Sears will conduct a national study of the impact of pre-operative mammography use on the efficiency and value of breast reduction surgery.