Operative timing and surgical complexity in hand trauma: a multicenter analysis of replantation and non-replantation centers in Germany

BACKGROUND: Hand injuries are common traumatic conditions that often require specialized surgical care. Differences in hospital structures and levels of specialization may influence the timeliness and complexity of treatment. This study evaluates quality of care across different hospital types, focusing on time-to-skin-incision and surgical management of finger and hand injuries. MATERIALS AND METHODS: This retrospective multicenter study is based on data from the HandTraumaRegister of the German Society for Hand Surgery (HTR DGH). A total of 16,726 surgically treated cases with documented finger or hand injuries recorded between 2018 and 2023 were analyzed. Hospitals were categorized as non-replantation centers, replantation centers, or FESSH-accredited replantation centers. Demographic characteristics, injury-patterns, treatment modalities, and time-related parameters were assessed. Statistical analysis included descriptive statistics, group comparisons, and multivariate regression models to evaluate factors associated with time-to-skin-incision. RESULTS: The study population consisted predominantly of male patients (75.79%), and 91.6% were right-handed. Soft tissue injuries without fractures or amputations accounted for 46.57% of cases. Non-replantation centers demonstrated the longest time-to-skin-incision (median 13 h), whereas replantation centers (median 3.75 h) and FESSH-accredited centers (median 4 h) showed significantly shorter times. Treatment strategies differed significantly between center types (p < 0.001), with non-replantation centers performing more secondary procedures. Replantations or revascularizations were performed in 3.96% of cases, with the highest proportion observed in FESSH-accredited centers (4.64%). Operative durations were significantly longer in replantation centers, particularly for complex and amputation injuries (p < 0.001). CONCLUSION: Specialized replantation centers are associated with shorter access times to surgical care compared to non-replantation centers. Longer operative times observed in highly specialized and FESSH-accredited centers may reflect greater injury complexity as well as the technical demands of advanced microsurgical procedures, rather than indicating differences in care quality. These findings highlight the potential relevance of specialized care structures in the management of severe finger injuries.