Children are at a higher risk of transfusion due to severe blood loss during salvage procedures after fingertip replantation: a retrospective matched case-control study

Purpose: This study compared outcomes and assessed transfusion risk factors in children and adults after fingertip replantation.Methods: From 2005 to 2019, 27 children (36 digits, 21 males and 6 females) underwent replantation due to either zone I or zone II amputation of digits. Twenty-seven adult patients (32 digits) were assigned to the control group based on matching criteria, including sex, diagnosis, level of amputation, and anastomotic vessels. Logistic regression analysis was performed to identify the risk factors for replantation failure in all subjects. Perioperative hemoglobin change, frequency of transfusion, and survival rates were compared between the groups.Results: The mean age at index surgery in the child and adult groups was 8.6 years (range, 6 months–16 years) and 47.3 years (range, 25–64 years), respectively (p<0.001). Although the survival rates in the child and adult groups after replantation of digits were not significantly different (p=0.242), the mean preoperative hemoglobin level and that on the postoperative day 2 were 12.8 g/dL vs. 14.3 g/dL (p<0.001) and 10.9 g/dL vs. 12.3 g/dL (p=0.002), respectively. The rate of transfusion in the child group was significantly higher than that in the adult group (8/27 patients vs. 1/27 patients, p=0.012). Younger age, type of anastomosis, and preoperative and postoperative day 2 hemoglobin levels are important risk factors for salvage procedure and transfusions after fingertip replantation.Conclusion: This case-control study showed that after replantation of fingertip amputation in children, hemodynamic changes in the perioperative periods were common, with a high transfusion rate.