Secondary Surgery following Initial Replantation/Revascularization or Completion Amputation in the Hand or Digits.

Background: The authors studied the rate of secondary surgery following replantation/revascularization or completion amputation in patients with traumatic upper extremity injuries. The authors hypothesized that there are no factors associated with secondary surgery after initial treatment and that travel distance to the authors' hospital does not influence the number of secondary operations.
Methods: A multi-institutional retrospective study was performed including patients presenting from 2006 to 2014. The authors included 1254 patients and calculated the incidence of secondary surgery following initial operative management. The authors 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 zero, one, or multiple secondary operations.
Results: The rate of secondary surgery was 25 percent for all patients: 51 percent following replantation/revascularization and 22 percent following completion amputation. The authors observed a trend for lower rate of secondary surgery over time among patients who underwent completion amputation. The mean number of secondary operations was 1.2 after replantation/revascularization versus 0.45 operations after completion amputation. Avulsion and multiple-digit injuries were associated with higher odds and Hispanic race was associated with lower odds of secondary surgery. Patients living more than 50 miles from the hospital had a higher likelihood of undergoing one or multiple secondary operations.
Conclusions: Twenty-five percent 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 with those undergoing completion amputation.
Clinical Question/level of Evidence: Risk, III.