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The Detrimental Effect of Patient Comorbidities on Digital Replantation Success in the United States
Joshua W. Hustedt, MD, MHS1; Michael Murri, BS2; Patricia Drace, MD3
1University of Arizona-Phoenix College of Medicine, Phoenix, AZ; 2Baylor College of Medicine, Houston, TX; 3Banner University Medical Center- Phoenix, Phoenix, AZ

Introduction: Recent reports suggest a decrease in success rates of digital replantation in the United States. We sought to determine the effect of patient comorbidities on digital replantation success in order to identify at risk populations for replantation failure.

Materials and Methods: All amputation injuries and digital replantations captured by the National Inpatient Sample during 1998-2012 were identified. Clinical Comorbidity Software was utilized to isolate preoperative patient comorbidities based on an Elixhauser Comorbidity Index. A successful procedure was defined as one in which a replantation occurred without a subsequent revision amputation. Patient comorbidities were tested for association with the success of the procedure.

Results: 15,822 replant procedures were identified. The overall rate of success of replants dropped from 74.5% during 2004-06 to 65.7% during 2010-12 (Relative Risk of replant failure [RR], 1.060; p<0.001). Pediatric patients (RR, 0.909; p=0.004), women (RR, 0.958;p<0.001) and both Hispanics (RR compared to whites, 0.935; p<0.001) and Asians (RR compared to whites, 0.852; p<0.001) had increased relative risks of replant success. Patients with anemia deficiency (RR, 1.172; p=0.002), depression (RR, 1.300; p<0.001), electrolytes disturbances (RR, 1.100; p=0.047), perivascular disease (RR, 1.261; p<0.001), and those with tobacco abuse (RR, 1.041; p=0.035) had decreased rates of replant success. Increasing cumulative number of comorbidities resulted in increasing risk of replant failure (RR, 1.252; p<0.001).

Conclusions: These data suggest that increasing patient comorbidities increases the risk of digital replant failure. Patients with preoperative anemia, depression, perivascular disease, and tobacco use are at a particularly high risk of replant failure. Patients with multiple comorbidities must be carefully counseled prior to digital replantation due to significantly increased risks of failure.

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