Psychiatric Morbidity After Digital Replantation Versus Amputation

BACKGROUND: The purpose of this study was to compare the psychological outcomes following digital amputations, successful digital replantation surgeries, and failed digital replantation surgeries. METHODS: The TriNetX database was queried to identify 19,238 patients who had undergone primary digital amputations, 383 patients who had successful digital replantation surgeries, and 253 patients with failed digital replantation surgery that required revision amputation. We then queried the database for new psychiatric diagnoses and for new psychotropic medication prescriptions within 3 years after the index surgery. RESULTS: Within the primary digital amputation group, the incidence of depression, generalized anxiety disorder, substance abuse, and adjustment disorder or post-traumatic stress disorder (PTSD) was 12.4%, 11.4%, 8.8%, and 5.2%, respectively. The incidence of depression, generalized anxiety disorder, substance abuse, and adjustment disorder or PTSD for all replantation surgery patients was 6.8%, 6.5%, 4.5%, and 6.3%, respectively. The incidence of depression, generalized anxiety disorder, and substance abuse were found to be significantly lower in all patients who underwent replantation surgeries compared with the primary amputation group. Meanwhile, the incidence of depression, generalized anxiety disorder, substance abuse, and adjustment disorder or PTSD for the successful replantation group was 6.5%, 6.3%, 3.9%, and 2.9% and was 6.7%, 5.5%, 4.0%, and 9.1%, respectively, for the failed digital replantation surgery cohort. CONCLUSIONS: The 3-year incidence of depression, generalized anxiety disorder, and substance abuse were found to be significantly lower in all patients who underwent replantation surgeries compared with the primary amputation group, regardless of the replantation success. These results are especially pertinent as replantation attempts trend downward in hand surgery.