39. Success Vs Failure in Digit Replantation: A Comprehensive Analysis of Post-operative Outcomes

PURPOSE: Digit replantation is a complex procedure with significant potential benefits and risks. While preoperative risk factors are well studied, the long-term consequences of replantation failure remain under-explored. Our study aims to compare the outcomes and complications between successful and failed digit replantations. METHODS: A retrospective cohort study was conducted using the TriNetX database. Patients who underwent digit replantation were categorized into two groups: successful replantation and replantation failure. Failure was defined as requiring amputation within 1 month. 30-day post-operative outcomes, including complications, reoperations, and psychological factors, were evaluated from time of replantation in the success group and amputation in the failure group. RESULTS: Of the 1,986 patients who underwent digit replantation after traumatic injury, 1,470 (67%) were successful. Replantation failure was associated with increased risk of infection (3.7% vs. 1.8%, p=0.02), necrosis (14.3% vs. 2.0%, p<0.0001), anesthesia for hand procedures (p<0.0001), debridement (5.6% vs. 2.7%, p=0.004), and nerve block procedures (33.8% vs. 27.5%, p=0.01). Patients with failed replantations were also more likely to experience adjustment disorder (2.7% vs. <1%, p=0.02) compared to successful cases. Patients who had successful replantation were more likely to require opioid analgesia (78.2% vs. 68.1%, p<0.0001). CONCLUSION: Patients who required amputation of their replanted digit had higher rates of infection, necrosis, reoperation, and psychological distress. Successful replantation increased the likelihood of opioid analgesia use. Careful patient selection and counseling are essential to balance the potential benefits of improved function and quality of life against the risks of complications and psychological distress associated with replantation.