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Digit replantation in children: a nationwide analysis of outcomes and trends of 455 pediatric patients

  • Surgery Articles
  • Published:
HAND

Abstract

Background

The short-term outcomes of pediatric digit replantation have been derived primarily from single-center/surgeon experience. The purpose of this study was to conduct a nationwide analysis of outcomes and trends of pediatric digit replantation as compared to adult patients.

Methods

Digit replantation patients were identified in the 1999–2011 Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Outcomes included in-hospital procedure-related and total complications, microvascular revision, amputation, and length of stay (LOS). Univariate and multivariate analyses were performed to compare pediatric and adult patients and to identify independent predictors of outcomes. The annual rate of replantation among pediatric digit amputation patients was evaluated over the study period.

Results

A total of 3,010 patients who underwent digit replantation were identified, including 455 pediatric patients. For all replantations, age ≤18 years was associated with a lower likelihood of suffering a total complication (odds ratio (OR) 0.66, P = 0.006), requiring amputation (OR 0.62, P < 0.001), and experiencing LOS >5 days (OR 0.77, P = 0.019), after adjusting for comorbidity, amputation severity, digit type, number of replantations, and hospital characteristics. Similar associations were observed between patient age and replantation outcomes for single-finger replantations. The rate of pediatric replantation (range 16 to 27 %) remained consistent through the study period (incidence rate ratio 0.98, P = 0.06).

Conclusions

The rate of pediatric replantation has been relatively low, being 27 % at most in a given year. Importantly, short-term outcomes are better in children than for adults, supporting the indication to perform replantation in this age group when the surgeon feels that replantation is feasible and safe.

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Conflict of Interest

Nicholas L. Berlin declares that he has no conflicts of interest.

Charles T. Tuggle declares that he has no conflicts of interest.

James G. Thomson declares that he has no conflicts of interest.

Alexander Au declares that he has no conflicts of interest.

Statement of Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Statement of Informed Consent

This study was deemed exempt from Institutional Review Board approval by our University Human Investigation Committee, as only publicly available, de-identified information was examined. No informed consent for this study was obtained given the nature of the data. HIC Protocol # 1401013202.

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Authors and Affiliations

  1. Yale University School of Public Health, 60 College St., P.O. Box 208034, New Haven, CT, 06520-8034, USA

    Nicholas L. Berlin

  2. Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd floor, New Haven, CT, 06510, USA

    Charles T. Tuggle, James G. Thomson & Alexander Au

Authors
  1. Nicholas L. Berlin
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  2. Charles T. Tuggle
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  4. Alexander Au
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Correspondence to Alexander Au.

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Berlin, N.L., Tuggle, C.T., Thomson, J.G. et al. Digit replantation in children: a nationwide analysis of outcomes and trends of 455 pediatric patients. HAND 9, 244–252 (2014). https://doi.org/10.1007/s11552-014-9628-8

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  • DOI: https://doi.org/10.1007/s11552-014-9628-8

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