"The Effect of Increasing Age on Outcomes of Digital Revascularization or Replantation".

PURPOSE: As the incidence of trauma in the elderly patient population increases, it is important to understand the risk-benefit profile of digital replantation or revascularization (DRR) surgery in this population. The aim of this study was to evaluate the impact of increasing age on rates of digital failure.

METHOD: A retrospective cohort study of DRR patients was undertaken from 2005 to 2016. Data collected consisted of patient demographics, smoking status, injury mechanisms, procedure types, as well as post-operative morbidity and mortality. Descriptive statistics and logistic regression were performed to assess outcomes. All comparisons were made between patients above and below the age of 60.

RESULTS: 283 patients underwent replantation or revascularization; 11% were above 60 years old. The majority of patients had multiple devascularized digits (70%), most commonly inflicted by a blade mechanism (77%). Approximately half of the patients underwent revascularization alone (54.4%). American Society of Anesthesiology (ASA) score and number of comorbidities were significantly greater in the older adult group. Overall, 88 (31%) patients experienced DRR failure, with 12 failures in the adults 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).

CONCLUSION: Older patients presented with significantly higher ASA and number of comorbidities, but did not experience higher rates of digital failure, major perioperative complications, or 30-day mortality. Adults 60 years or older should be offered DRR if medically or surgically indicated.