Effect Of Daytime Versus Overnight Digit Replantation On Surgical Outcomes
Alfred P. Yoon, MD, I-Chun Lin, BA, Lingxuan Kong, MS, Lu Wang, PhD, Kevin C. Chung, MD,MS.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: Recent evidence suggests that delayed replantation do not adversely impact digit survival; however, its impact on other outcomes is unknown. We hypothesized that there will be no difference in digit survival, complication rate, duration of surgery, or inpatient length of stay between daytime and overnight replantations.
METHODS: A single-center retrospective analysis was conducted for all replantations between January 1st, 2000 and August 1st, 2021. We examined digit survival, total number of complications, duration of surgery, and hospital length of stay. Replantations starting between 7 AM and 4 PM were defined as daytime surgery, whereas overnight surgeries started outside of that period. Logistic and linear regressions adjusting for comorbidities, ischemia time, number of arterial and venous anastomoses, surgeon type, and procedure difficulty score (determined by smoking status, amputation level, multi-finger injury, mechanism of injury) were used to investigate associations between surgery time and outcomes.
RESULTS: 147 replanted digits were included for analysis. Overnight replantation was associated with 0.5 less complications (beta coefficient (β) -0.5, 95% CI -0.9 to -0.2), 110 minutes shorter operative time (β -110, 95% CI -181 to -39), and 23% decreased postoperative length of stay (log β -0.2, 95% CI -0.41 to 0) compared to daytime replantation. There were no differences in digit survival between daytime and overnight replantations.
CONCLUSION: Overnight replantation is independently associated with lower complications, shorter duration of surgery, and decreased postoperative length of stay compared to daytime surgery; therefore, we refute the null hypothesis. When possible, overnight replantations should not be delayed.
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