Helene Retrouvey1, Ogi Solaja1, Heather L Baltzer1. 1. From the Division of Plastic and Reconstructive Surgery, University of Toronto; Hand Program, Toronto Western Hospital; and the School of Medicine, Queen's University.
Abstract
BACKGROUND: The aim of this study was to evaluate the impact of increasing age on rates of digital failure. METHOD: A retrospective cohort study of digital replantation or revascularization patients was undertaken from 2005 to 2016. Data collected consisted of patient demographics, smoking status, injury mechanisms, procedure types, and postoperative morbidity and mortality. Descriptive statistics and logistic regression were performed to assess outcomes. All comparisons were made between patients older than and younger than 60 years. RESULTS: Two hundred eighty-three patients underwent replantation or revascularization; 11 percent were older than 60 years. The majority of patients had multiple devascularized digits (70 percent), most commonly inflicted by a blade mechanism (77 percent). Approximately half of the patients underwent revascularization alone (54.4 percent). American Society of Anesthesiologists score and number of comorbidities were significantly greater in the older adult group. Overall, 88 patients (31 percent) experienced digital replantation or revascularization failure, with 12 failures in patients aged 60 years or older. Multivariate logistic regression demonstrated that age did not have an impact on failure rate. Older patients did not experience more major complications, but had significantly higher rates of minor complications (p = 0.0485). CONCLUSIONS: Older patients presented with significantly higher American Society of Anesthesiologists physical status and number of comorbidities, but did not experience higher rates of digital failure, major perioperative complications, or 30-day mortality. Adults aged 60 years or older should be offered digital replantation or revascularization if medically or surgically indicated. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
BACKGROUND: The aim of this study was to evaluate the impact of increasing age on rates of digital failure. METHOD: A retrospective cohort study of digital replantation or revascularization patients was undertaken from 2005 to 2016. Data collected consisted of patient demographics, smoking status, injury mechanisms, procedure types, and postoperative morbidity and mortality. Descriptive statistics and logistic regression were performed to assess outcomes. All comparisons were made between patients older than and younger than 60 years. RESULTS: Two hundred eighty-three patients underwent replantation or revascularization; 11 percent were older than 60 years. The majority of patients had multiple devascularized digits (70 percent), most commonly inflicted by a blade mechanism (77 percent). Approximately half of the patients underwent revascularization alone (54.4 percent). American Society of Anesthesiologists score and number of comorbidities were significantly greater in the older adult group. Overall, 88 patients (31 percent) experienced digital replantation or revascularization failure, with 12 failures in patients aged 60 years or older. Multivariate logistic regression demonstrated that age did not have an impact on failure rate. Older patients did not experience more major complications, but had significantly higher rates of minor complications (p = 0.0485). CONCLUSIONS: Older patients presented with significantly higher American Society of Anesthesiologists physical status and number of comorbidities, but did not experience higher rates of digital failure, major perioperative complications, or 30-day mortality. Adults aged 60 years or older should be offered digital replantation or revascularization if medically or surgically indicated. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
Authors: Khodayar Goshtasbi; Mehdi Abouzari; Sina Soltanzadeh-Zarandi; Brooke Sarna; Ariel Lee; Frank P K Hsu; Hamid R Djalilian Journal: Clin Neurol Neurosurg Date: 2020-08-28 Impact factor: 1.876