Secondary Surgery following initial replantation/revascularization or completion amputation in the hand or digits

Background: We studied the rate of secondary surgery following replantation/revascularization or completion 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. 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 completion amputation. We observed a trend for lower rate of secondary surgery over time among patients who underwent completion amputation. The mean number of secondary surgeries was 1.2 secondary operations after replantation/revascularization vs. 0.45 operations after completion 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. Conclusion: 25% of patients with traumatic, dysvascular digital injuries underwent secondary surgery following initial revascularization or completion amputation. Patients undergoing initial revascularization or replantation were more than twice as likely to undergo secondary surgery compared to those undergoing completion amputation. Financial Disclosure Statement: Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethical review committee statement: The Institutional Review Board of our institution approved this study under protocol #2009P001019/MGH Corresponding Author: Kyle R. Eberlin, MD, Hand Surgery Service, Division of Plastic Surgery, Assistant Professor of Surgery, Harvard Medical School, Associate Program Director, MGH Hand Surgery Fellowship, Massachusetts General Hospital, 55 Fruit St, WAC 435, Boston, MA 02114, keberlin@mgh.harvard.edu ©2018American Society of Plastic Surgeons

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