American Society for Peripheral Nerve
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Penetrance of TMR Among a Diverse Amputation Population at a Large Academic Medical Center- Gaps Highlighted by An 8-year Retrospective Review
Gunel Guliyeva, MD1; Jason M Souza, MD2
1The Ohio State University, Columbus, OH; 2Plastic Surgery, The Ohio State University, Columbus, IL

PURPOSE: Presently, more than 2 million amputees are estimated to live in the USA and a considerable portion of these patients suffer from debilitating nerve pain. 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. In an effort to improve access to TMR, we aimed to better understand recent practice patterns in order to identify barriers to implementation of TMR as a component of amputation care.
METHODS: A single-center retrospective study was conducted using CPT codes. Patients who were admitted at OSUWMC within the last eight years (January 2014 to December 2021) and underwent below (27880) or above-knee (27590) amputation were identified. Subsequently, the subset of the patients who had the TMR (64905, 64784, 64874, 64787, 20926, 24905) was identified. Patient demographics, surgical details, and the attending surgeon (names of the providers and their affiliated department) were recorded.
RESULTS: 1668 records were identified. The total number of amputation surgeries performed grew significantly throughout the study period. The majority of the amputation surgeries (59%) were performed by vascular surgery, followed by orthopedic surgery (34%). Surgical oncology, trauma, burn, plastic, and thoracic surgery performed a minimal portion of amputations (7% combined). While 17.3% of orthopedic surgery amputees underwent TMR, only 0.7% of vascular surgery patients had TMR performed during or after amputation. While the percentage of orthopedic surgery patients undergoing TMR increased from 11% to 57%, a similar trend was not observed for vascular surgery patients, where penetrance ranged from 0-2%. .
CONCLUSIONS: Despite being an institution considered to be an early adopter of TMR, only a small minority of amputees treated at OSUWMC have undergone TMR as part of their amputation care, and rates of adoption have varied widely between surgical departments. Current efforts at care coordination and collaboration have proven ineffective. Novel, department-specific strategies are needed to improve access to TMR across the landscape of amputation care provided at a large, academic medical center.


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