The Effect of Increasing Age on Outcomes of Digital Revascularization or Replantation

Purpose: As the elderly patient population grows and as trauma to this population increases, it is important to understand whether the risks of a lengthy procedure outweigh the benefits. The aim of this study is to evaluate whether increasing age was a predictor of digital failure in patients undergoing digital replantation or revascularization. Method: A retrospective cohort study of digital replantation and revascularization patients was undertaken from 2005 to 2016. Data collected consisted of patient demographics, comorbidities, smoking status, procedure types, as well as postoperative morbidity and mortality. Descriptive statistics, chisquare, and logistic regression were performed to assess outcomes. Patients were divided by age above and below 60 for analysis. Results: During the study period, 295 patients underwent replantation or revascularization (12% elderly and 91.9% male); 36% underwent replantation, 56% revascularization, and 8% both. Smoking status and number of digits injured were similar between the groups. Comorbidities were more frequent in elderly patients (64% vs 33%; P = .0002). Higher American Society of Anesthesiology score (ASA) was present in the elderly group (P = .02). Morbidity was noted in 135 patients: 55 in-hospital and 80 postdischarge. Of these, 16% in-hospital and 11% postdischarge were experienced by elderly patients. Ninety-one (30.64%) patients experienced digital failures, with 11 % of failures in the elderly patients. Morbidity and digital failure rates were nonstatistically different between the groups. Multivariate logistic regression controlling for sex, ASA, comorbidities, number of digits, and smoking demonstrated that age did not impact failure rate. Conclusion: Elderly patients presented with significantly more comorbidities and higher ASA scores as compared to their younger peers. Despite this, elderly patients did not experience higher rates of digital failure. Elderly patients should be offered replantation if medically or surgically indicated. Learning Objectives: (1) Discuss factors impacting revascularization or replantation digit failure. (2) Review the impact of increasing age on digit failure.