title: Evaluating the Effect of Comorbidities on the Success, Risk, and Cost of Digital Replantation.
abstract: OBJECTIVE
  The clinical decision to replant an amputated digit is driven primarily by surgical indication. However, the extent to which patient comorbidity should play into this decision is less well defined. This study was designed to determine the effect of patient comorbidities on the success, risk, and cost of digital replantation.
  
  
  METHODS
  All amputation injuries and digital replantation procedures captured by the National Inpatient Sample during 2001 to 2012 were identified. A successful replantation procedure was defined as one in which a replantation occurred without a subsequent revision amputation. Patient comorbidities were tested for association with failure of replantation, risk of postoperative complications, and overall hospital costs.
  
  
  RESULTS
  We identified 11,788 digital replantation procedures. A total of 3,604 patients (30.6%) experienced revascularization failure associated with replantation. The risk for replant failure was highest among patients with psychotic disorders, peripheral vascular disease, and electrolyte imbalances. The risk for postoperative complications was highest among patients with electrolyte imbalances, drug abuse, or chronic obstructive pulmonary disease. Hospital costs were greatest among patients with deficiency anemias, electrolyte imbalances, or psychotic disorders. Patients with more than 3 comorbidities experienced significantly higher failure, risk of postoperative complications, and cost of digital replantation.
  
  
  CONCLUSIONS
  These data suggest that even when surgical indications are met, patients with more than 3 comorbidities and those who have a history of alcohol abuse, deficiency anemias, electrolyte imbalances, obesity, peripheral vascular disease, or psychotic disorders are at increased risk of replantation failure and associated postoperative complications. Assessment of this risk should have a role in decision making regarding whether a digit should be replanted. Patients at high risk should be carefully counseled regarding the difficult perioperative course before undergoing digital replantation.
  
  
  METHODS
  Prognostic III.
authors.affiliation: Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ. Electronic address: Joshua.hustedt@bannerhealth.com.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Hustedt
authors.affiliation: Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chung
authors.affiliation: Department of Orthopedics, Rush University Medical Center, Chicago, IL.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.affiliation: Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.
authors.forename: Neil
authors.initials: N
authors.lastname: Olmscheid
authors.affiliation: Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Center for Orthopedic Research and Education, Phoenix, AZ.
authors.forename: Scott
authors.initials: S
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000191:economics / Q000379:methods; D012092:Replantation / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Hand surgery; amputation traumatic; comorbidity; orthopedics; replantation