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Age Is Not a Factor in Finger Replantation

Fears that older age (65 or older) increases the risk of complications (including death) from finger replantation can be set aside. According to this study from Stanford University, the risk of serious blood clots leading to death after surgery to reattach a thumb or finger in the older age group is no different than in the younger crowd.

They determined this by reviewing the medical records of 616 patients across the U.S. who had this surgery done over a 10-year period of time. The data was taken from the Nationwide Inpatient Survey (NIS). Information collected at the time of hospital discharge is placed in this database and can be used by all researchers. No patient is identified, so it is confidential.

To give you a little perspective on this topic, compared to the 616 patients over the age of 65 who had a digit replantation, there were almost 15,000 of these procedures done in younger patients (under 65). In case you are puzzled over the meaning of the term digit replantation, it simply refers to the reattachment of a finger or thumb that has been accidentally cut off.

There were complications for patients in the older group. Blood clots, bleeding, pressure ulcers, and accidental cuts were reported. But the percentage of patients affected was less than one per cent (0.6 per cent). Death occurred in an even smaller number (0.04 per cent).

Age as a risk factor for death following digit replantation just wasn't a factor. But that doesn't mean that age should be ignored. Older adults who had a digit replantation were twice as likely to need a blood transfusion. Discharge to a nursing home rather than directly to the patient's home was also more likely in the older age group.

Although this study did not analyze survival rates of the finger (or thumb), other studies have reported no difference based on age. Patients with diabetes or who smoke are at risk for less optimal outcomes compared with those without these risk factors.

Survival of the digit is one variable; function is something else. In other words, the patient may not lose the finger but he or she may not have good use (function) of the digit. Survival versus function was not studied in this study and may be the basis of future studies.

In summary, age (along with all other factors) should be taken into consideration when planning treatment for a finger or thumb amputation. But age should not be a reason to avoid replantation. Surgeons keep in mind the idea that "life comes before limb" (i.e., don't put someone at risk of death to save a finger). The results of this study show that older adults can have both!

Reference: Ario Barzin MD, et al. Adverse Events Following Digital Replantation in the Elderly. In The Journal of Hand Surgery. May 2011. Vol. 36A. No. 5. Pp. 870-874.

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