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Psychiatric Outcomes after Digital Replantation Versus Primary Digital Amputation
Amy Phan, MD
1, Christopher M Dussik, MD
2, Thomas Carroll, MD
1, Jeffrey Coombs, MD
2, Bilal Mahmood, MD
1, Constantinos Ketonis, MD, PhD
2; Danielle M Wilbur, MD
2(1)University of Rochester, Rochester, NY, (2)University of Rochester Medical Center, Rochester, NY
Introduction:The loss of a limb is a physical and psychological trauma that can result in conflicts of loss and dependency. The purpose of this study was to compare the psychological outcomes following digital amputations, successful digital replantation surgeries, and failed digital replantation surgeries.
Materials and Methods:This was a retrospective cohort study performed using the TriNetX database, which was queried using the appropriate Current Procedural Terminology (CPT) or International Classification of Diseases (ICD) codes. We found 19,146 patients who had undergone primary digital amputations, 570 patients who had successful digital replantation surgeries, and 264 patients with failed digital replantation surgery that required revision amputation. We then queried the database for new diagnoses of depression, generalized anxiety disorder, substance abuse, and PTSD or adjustment within 3 years after the index surgery.
Results:Within the primary digital amputation group, the incidence of depression, generalized anxiety disorder, substance abuse, and adjustment disorder or PTSD was 11.9%, 10.8%, 8.3%, and 4.9% respectively. The incidence of depression, generalized anxiety disorder, substance abuse, and adjustment disorder or PTSD for all replantation surgery patients was 7.3%, 6.4%, 4.9%, and 6.6% respectively. The incidence of depression, generalized anxiety disorder, and substance abuse were found to be significantly lower in all patients who underwent replantation surgeries compared to the primary amputation group (p < 0.05). Meanwhile, the incidence of depression, generalized anxiety disorder, substance abuse, and adjustment disorder or PTSD for the successful replantation group was 7.5%, 6.0%, 3.5%, and 4.2%, and was 6.1%, 5.3%, 5.3%, and 9.8% respectively for the failed digital replantation surgery cohort.
Conclusions:With the exception of adjustment disorder/PTSD, the incidence of all the psychiatric outcomes listed were found to be significantly lower in all patients who underwent replantation surgeries compared to the primary amputation group, regardless if the replantation was successful. Interestingly, patients who had undergone digital replantation surgeries that ultimately failed had a statistically higher incidence of adjustment disorder/PTSD compared to those who received a digital amputation as the initial treatment at three years postoperatively. These results are especially pertinent as replantation attempts trend downward in hand surgery.
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