P59. Patient and Injury-related Predictors of Digit Replantation Failure: Implications of Preoperative Nicotine Dependence

PURPOSE: Digit replantation is a complex procedure that requires optimal wound healing. There are conflicting data on the impact of smoking on replantation success. This study evaluated the association between smoking and replantation failure in the context of other risk factors. METHODS: A federated database of electronic medical records, TriNetX, was used to identify patients who underwent digit replantation. Clinical characteristics, substance use, and intraoperative variables were evaluated to identify risk factors for replantation failure, defined as amputation within 1 month. Propensity score matching was used to control for confounding variables. RESULTS: Of 2,130 patients, 659 (31%) experienced failure and 380 (18%) were smokers. Risk factors for replantation failure included injury due to machinery (RR 1.30, p=0.003), injury at construction/industrial location (RR 1.44, p=0.003), white race (RR 1.22, p=0.01), smoking (RR 2.22, p=0.007), cocaine disorder (RR 1.68, p=0.04), anemia (RR 1.43, p=0.003) and vein graft use (RR 1.48, p=0.0002). After adjusting for confounding variables, smoking was not independently associated with increased risk of failure (p=0.053). Notably, smokers were equally likely to undergo replantation compared to non-smokers (p=0.12). CONCLUSION: While smoking was initially associated with increased risk, this association was no longer significant after adjusting for other factors. Further research is needed to explore the potential impact of smoking on replantation outcomes.