Pediatric Digit Replantation: An Analysis of Complication and Failure Rates of 796 Pediatric Patients
Andrew R Stephens, BS, Jacob Wilkes, MS and Nikolas H Kazmers, MD MSE, University of Utah, Salt Lake City, UT
Background: Function and cosmesis may be improved by replantation following digital amputation in pediatric patients. However, accurate failure and complication rate estimates may be limited as most pertinent studies reflect single center/surgeon experience and therefore are limited by small sample sizes. The primary aim of this study was to assess the rate of failure (amputation) after pediatric replantation. Secondary aims include evaluating the rate of complications and associated resource utilization (readmission rate, costs and hospital utilization).
Methods: Digital replantation patients were identified from 47 pediatric hospitals using the 2004 - 2020 Pediatic Health Information System (PHIS) nation wide database. Using applicable ICD 9/10 and CPT codes, we identified possilbe complications after replantation icluding: revision amputation, 30 days, infections, surgical complications, medical complications, admission to intensive care unit (ICU), length of stay (LOS). Surgical cost of replantation was also determined using the PHIS database.
Results: Of the 796 patients who underwent replantation the mean age was 5.6 ± 4.8 years and 41% were female. Of the 278 (35%) admitted patients, mean length of stay (LOS ) was 5.4 ± 4.1 days. Of the 17% of patients who required ICU admission, mean LOS was 0.7 ± 2.1. Failure/Amputation after replantation occurred in 89 (11%) patients, which occurred at 27.2 ± 59.7 days (IQR: 0, 23) postoperatively. Same visit surgical complications occurred in 42 (5%) patients. Hospital 30-day readmissions occurred 24 (3%) patients. Within 30 days after replantation, 2 patients were seen for a medial complication, 70 (9%) for a surgical complication, and 31 (4%) with an infection. Median cost of the surgery was (IQR: 2110, 21908).
Conclusion: The estimated rate of failure following pediatric digit replantation was 11%, which is qualitatively lower than Berlin et al.'s database study (18.5%) which only included admitted patients. Our data on failure and complication rates, and associated resource utilization, may be useful in counseling pediatric replantation patients and their families.
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