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Number of microsurgery procedures in decline, particularly replantations
Survey finds ASSH members perform less microsurgeries; some have low confidence in microsurgery skills.
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WASHINGTON — Members of the American Society for Surgery of the Hand reported a low rate of microsurgery replantations in a recent Internet-based survey, according to a surgeon speaking here. Most respondents cited low reimbursement rates, busy elective schedules and low confidence in their microsurgical skills as reasons, he noted.
Of 1,533 contacted members, 711 (46%) responded to the 35-item anonymous survey. Only 59% reported performing replantations and, of those respondents, 64% indicated they performed fewer than five replantations annually, according to L. Scott Levin, MD, of Durham, N.C.. He presented the study results at the American Society for Surgery of the Hand 61st Annual Meeting.
According to the study, 75% of those surgeons who reported performing microsurgery saw a gradual decrease in procedure rates over the past 10 years. Respondents attributed the decline to several factors, as follows:
- limited indications, 85%;
- fewer amputations, 27%;
- poor reimbursement, 4%;
- too few surgeons, 1.5%; and
- implications regarding quality of life, 1.2%.
Among surgeons who did not perform replantations, 48% attributed their decision to busy elective schedules and 37% to lack of confidence in their microsurgical skills, Levin said. However, 29.5% of these respondents indicated they may reconsider performing replantations if reimbursement rates improved, he noted.
"A multitude of socioeconomic, educational and practical issues combined to discourage the clinical application of microsurgical skills by members of this society," Levin said. "This unfavorable environment should be addressed by policy making organizations ... and continuous medical education and training ... to arrest what we believe is a sobering decline in quality of care for our patients."
Despite high ratings for fellowship training, the respondents also reported low rates for current microsurgical skills. Seventy percent rated their fellowship training as excellent and another 24% rated their training as good, but only 58% considered their current microsurgical skills above average or excellent.
"Sixty percent said they would favor CME courses designed to enhance microsurgical skills," Levin said. "The demand for microsurgical and flap techniques courses was on par with or exceeded [other] courses."
For more information:
- Payatakes AH, Zagoreos NP, Levin LS. Practice of microsurgery by ASSH members: A sobering decline. #04. Presented at the American Society for Surgery of the Hand 61st Annual Meeting. Sept. 7-9, 2006. Washington.