Secondary Surgery Following Initial Replantation/Revascularization or Revision Amputation in the Hand or Digits
Malini S Chinta, MS; Suzanne Caroline Wilkens, MD; Margot A. Vlot, BSc; Neal C. Chen, MD; Kyle R. Eberlin, MD
Massachusetts General Hospital, Boston, MA
Introduction: We studied the rate of secondary surgery following replantation/revascularization or revision amputation in patients with traumatic upper extremity injuries. We hypothesized that there are no factors associated with secondary surgery after initial treatment and that travel distance to our hospital does not influence the number of secondary operations.
Materials & Methods: A multi-institutional retrospective study was performed including patients presenting from 2006 to 2014. We included 1,254 patients and calculated the incidence of secondary surgery following initial operative management. We performed multivariable regression analysis to determine factors associated with secondary surgery and ordinal logistic regression tested the association of living at a further distance (> 50 miles) and having 0, 1 or multiple secondary surgeries.
Results: The rate of secondary surgery was 25% for all patients: 51% following replantation/revascularization and 22% following revision amputation. We observed a trend for lower rate of secondary surgery over time among patients who underwent initial revision amputation. The mean number of secondary surgeries was 1.2 after replantation/revascularization vs. 0.45 operations after revision amputation. Avulsion and multiple digit injuries were associated with higher odds and Hispanic race with lower odds of secondary surgery. Patients living > 50 miles from the hospital had a higher likelihood of undergoing 1 or multiple secondary surgeries.
Conclusions: 25% of patients with traumatic, dysvascular digital injuries underwent secondary surgery following initial revascularization or revision amputation. Patients undergoing initial revascularization or replantation were more than twice as likely to undergo secondary surgery compared to those undergoing revision amputation.
Include figure: Kaplan Meier curve demonstrating the probability of secondary surgery (1 - probability of survival) among patients undergoing A. Initial revascularization or B. Revision amputation.
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