Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor.
School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor.
JAMA Netw Open. 2022 Sep 1;5(9):e2229526. doi: 10.1001/jamanetworkopen.2022.29526.
Recent evidence suggests that select delayed replantation may not adversely affect digit survival; however, whether surgical timing (overnight or daytime) is associated with digit replantation outcomes is unknown.
To assess whether digit survival, complication rate, and duration of surgery are associated with time of replantation.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series study included all replantations performed at a single tertiary referral academic center between January 1, 2000, and August 1, 2021. Data were analyzed between October 2, 2021, and January 1, 2022. Four daytime surgery intervals were selected based on literature review. Daytime replantations started within the intervals whereas overnight replantations began outside the intervals. For each case, the procedure difficulty score and the attending surgeon expertise score were calculated. Logistic and linear regressions adjusting for confounders including procedure difficulty score and expertise score were used to assess surgical timing and outcomes. Participants were adults (aged ≥18 years) undergoing digit replantations between January 2000 and August 2021 with at least 1-month follow-up. Replantation was defined as the reattachment of a completely amputated digit that necessitated anastomosis of both artery and vein.
Daytime or overnight digit replantation.
Viable replanted digit at 1-month follow-up, number of complications, and duration of surgery.
A total of 98 patients (mean [SD] age, 39.5 [15.3] years; 136 [93%] men) and 147 digits met inclusion criteria. Overall success rate was 55%. Between 4 pm and 7 am, overnight replantations were associated with 0.4 fewer complications (β, -0.4; 95% CI, -0.8 to -0.1) and 90.7 minutes shorter operative time (β, -90.7; 95% CI, -173.6 to -7.7). A 1-point increase in surgeon expertise score was associated with 1.7 times increased odds of replantation success for all intervals (adjusted odds ratio, 1.7; 95% CI, 1.2 to 2.4; P = .002). There were no differences in digit survival by surgical time.
In this case series study of digit replantations, time of operation was not associated with replantation success. Overnight replantation was associated with fewer complications and shorter duration of surgery compared with daytime surgery. Results of this study suggest that overnight replantations may be performed with outcomes comparable to daytime replantations at a tertiary care academic center.
最近的证据表明，选择延迟再植可能不会对指体存活产生不利影响；然而，手术时间（夜间或白天）是否与指体再植的结果有关尚不清楚。
评估指体存活、并发症发生率和手术时间是否与再植时间有关。
设计、地点和参与者：本回顾性病例系列研究纳入了 2000 年 1 月 1 日至 2021 年 8 月 1 日期间在一家三级转诊学术中心进行的所有再植手术。数据于 2021 年 10 月 2 日至 2022 年 1 月 1 日进行分析。根据文献综述选择了四个白天手术间隔。白天的再植手术在间隔内开始，而夜间的再植手术在间隔外开始。对于每个病例，计算了手术难度评分和主治医生的专业技能评分。使用调整混杂因素（包括手术难度评分和专业技能评分）的逻辑和线性回归来评估手术时间和结果。参与者为 2000 年 1 月至 2021 年 8 月期间接受指体再植的成年人（年龄≥18 岁），随访时间至少为 1 个月。再植是指完全切断的指体重新连接，需要吻合动脉和静脉。
白天或夜间的指体再植。
1 个月随访时存活的再植指体、并发症数量和手术持续时间。
共纳入 98 例患者（平均[标准差]年龄为 39.5[15.3]岁；136[93%]为男性）和 147 个指体。总体成功率为 55%。下午 4 点至早上 7 点之间，夜间再植的并发症减少 0.4 个（β，-0.4；95%CI，-0.8 至-0.1），手术时间缩短 90.7 分钟（β，-90.7；95%CI，-173.6 至-7.7）。主治医生的专业技能评分每增加 1 分，所有间隔的再植成功率增加 1.7 倍（调整后的优势比，1.7；95%CI，1.2 至 2.4；P=0.002）。手术时间与指体存活率无差异。
在这项对指体再植的病例系列研究中，手术时间与再植成功率无关。与白天手术相比，夜间再植的并发症更少，手术时间更短。本研究结果表明，在三级医疗机构进行夜间再植，其结果可能与白天再植相当。
