Digit replantation in children: a nationwide analysis of outcomes and trends of 455 pediatric patients.
BACKGROUND
The short-term outcomes of pediatric digit replantation have been derived primarily from single-center/surgeon experience. The purpose of this study was to conduct a nationwide analysis of outcomes and trends of pediatric digit replantation as compared to adult patients.


METHODS
Digit replantation patients were identified in the 1999-2011 Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Outcomes included in-hospital procedure-related and total complications, microvascular revision, amputation, and length of stay (LOS). Univariate and multivariate analyses were performed to compare pediatric and adult patients and to identify independent predictors of outcomes. The annual rate of replantation among pediatric digit amputation patients was evaluated over the study period.


RESULTS
A total of 3,010 patients who underwent digit replantation were identified, including 455 pediatric patients. For all replantations, age ≤18 years was associated with a lower likelihood of suffering a total complication (odds ratio (OR) 0.66, P = 0.006), requiring amputation (OR 0.62, P < 0.001), and experiencing LOS >5 days (OR 0.77, P = 0.019), after adjusting for comorbidity, amputation severity, digit type, number of replantations, and hospital characteristics. Similar associations were observed between patient age and replantation outcomes for single-finger replantations. The rate of pediatric replantation (range 16 to 27 %) remained consistent through the study period (incidence rate ratio 0.98, P = 0.06).


CONCLUSIONS
The rate of pediatric replantation has been relatively low, being 27 % at most in a given year. Importantly, short-term outcomes are better in children than for adults, supporting the indication to perform replantation in this age group when the surgeon feels that replantation is feasible and safe.
Yale University School of Public Health, 60 College St., P.O. Box 208034, New Haven, CT 06520-8034 USA.
Nicholas L
NL
Berlin
Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd floor, New Haven, CT 06510 USA.
Charles T
CT
Tuggle
Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd floor, New Haven, CT 06510 USA.
James G
JG
Thomson
Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, 330 Cedar Street, Boardman Building, 3rd floor, New Haven, CT 06510 USA.
Alexander
A
Au
Digit Replantation; Microsurgery; Outcomes; Pediatric