Premium
Effect of vasopressor use on digit survival after replantation and revascularization—A large retrospective cohort study
Author(s) -
Retrouvey Helene,
Makerewich Jacqueline R.,
Solaja Ogi,
Giuliano Anthony M.,
Niazi Ahtsham U.,
Baltzer Heather L.
Publication year - 2020
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30461
Subject(s) - medicine , replantation , retrospective cohort study , revascularization , anesthesia , ephedrine , surgery , odds ratio , tourniquet , avulsion , phenylephrine , blood pressure , myocardial infarction
Purpose Despite the common use of intraoperative vasopressors in hand microsurgery, the association between intraoperative vasopressor use and digital replant failure has not yet been examined. Our study aims to examine the association between intraoperative vasopressor use (phenylephrine and/or ephedrine) and postoperative digital failure of replanted or revascularized digits. Methods All patients from a single tertiary hand center who underwent unilateral digital replantation or revascularization procedures between 2005 and 2016 were included in this retrospective cohort study. The relationship between intraoperative vasopressors used to maintain hemodynamic stability and digit failure was then evaluated using logistic regression. Specifically, phenylephrine (total dose 10–3,600 mcg) and ephedrine (5–110 mg) use were evaluated. Results During the study period, 281 patients underwent digital replantation or revascularization. Of those, 86 (31%) were given an intraoperative vasopressor. Digit failure was more likely in patients with crush or avulsion injuries compared to clean‐cut mechanism (odds ratio [OR] 2.02, p = .02), and in patients with replantation (OR 7.85, p < .0001) as compared to revascularization procedures. Using multivariate logistic regression adjusting for age, sex, smoking status, comorbidities, number of digits injured, injury type, and procedure type, the odds of digital failure with vasopressor use were not increased ( p = .84). When evaluating vasopressors used after tourniquet deflation, failure increased with ephedrine use (OR = 2.42, p = .0496) and phenylephrine use (OR = 2.21, p = .31). Conclusions The use of vasopressors was not associated with failure if administration of vasopressors was before tourniquet deflation. The administration of vasopressors after tourniquet deflation should be cautioned.