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Determination of the Penetrance of TMR Among a Diverse Amputee Population at a Large Academic Medical Center
Gunel Guliyeva, MD, Jason M. Souza, MD, FACS
The Ohio State University Wexner Medical Center, Department of Plastic and Reconstructive Surgery
2023-02-01
Presenter: Gunel Guliyeva
Affidavit:
Jason M. Souza
The student has contributed to more than 70% of the original work.
Director Name: Jason M. Souza
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
PURPOSE:
Targeted Muscle Reinnervation (TMR) has been demonstrated to decrease post-amputation pain, and recent reports suggest a benefit to earlier intervention. However, access to TMR can be variable based on patient, practice, and institutional factors. Therefore, to improve access to TMR, we aimed to understand recent practice patterns better to identify barriers to implementing TMR as a component of amputation care.
METHODS:
A single-center retrospective study was conducted using CPT codes. First, patients treated at OSUWMC over the last eight years (2014-2021) and underwent above-(27590) or below-knee amputation were identified. Subsequently, the subset of the patients who underwent the TMR (64905, 64784, 64874, 64787, 20926, 24905) was determined. In addition, patient demographics, surgical details, and affiliated departments of the primary surgeons were recorded.
RESULTS:
One thousand six hundred sixty-eight records were identified. Most amputation surgeries (59%) were performed by vascular surgery and orthopedic surgery (34%) departments. Other departments performed the remaining 7% of the amputations.
While 17.3% of orthopedic surgery amputees underwent TMR, this number was only 0.7% for vascular surgery patients. During this time period, the penetrance of TMR for orthopedic surgery patients rose from 11% to 57%. However, this observation was not true for vascular surgery patients (penetrance, 0-2%).
CONCLUSIONS:
Only a minority of amputees treated at OSUWMC have undergone TMR as part of their amputation care, and rates of TMR adoption have varied widely between surgical departments. Therefore, novel department- and institution-specific strategies are required to improve patient access to TMR.
