End-Stage Renal Disease as a Predictor of Ray Amputation and Other Postoperative Sequelae in Finger Amputation.

PURPOSE: Patients with end-stage renal disease (ESRD) have high rates of pathologies, which may necessitate finger amputation, such as infection or vascular insufficiency. Still, little work has examined its significance in upper-extremity amputation. This study aimed to explore ESRD as a predictor of postoperative sequelae in the setting of finger amputation.

METHODS: A retrospective cohort study was performed using the TriNetX database to identify patients with finger amputation through the phalanx, metacarpal, or distal to the carpometacarpal with or without preexisting ESRD or dependence on dialysis. Propensity score matching was used to control for risk factors such as diabetes, atherosclerosis, peripheral vascular disease hypertension, among others. Outcomes included return to operating room or death within 1-year, subsequent ray amputation, proximal upper-extremity amputation, and other common sequelae of finger amputation.

RESULTS: After propensity score matching, 1,619 patients without and 1,619 patients with ESRD or dialysis dependence before index finger amputation were in each cohort. More patients with ESRD returned to the operating room within 1 year for debridement or secondary closure of dehisced wound (334 [20.63%] vs 217 [13.40%]). Furthermore, 338 (20.88%) non-ESRD amputees and 536 (33.11%) ESRD amputees underwent repeat or subsequent ray amputation. Similarly, patients with ESRD demonstrated higher rates of proximal upper extremity amputation (ie, at the hand, wrist, or forearm) following index surgery: 296 (18.28%) patients without ESRD versus 481 (29.71%) patients with ESRD. ESRD amputees also developed significantly higher rates of chronic osteomyelitis (290 [17.91%] vs 219 [13.53%], P < .001) as well as death within 1 year (375 [23.16%] vs 121 [7.47%], P < .001).

CONCLUSIONS: Patients with ESRD experience higher rates of subsequent proximal upper extremity amputation, subsequent ray amputation, chronic osteomyelitis, return to the operating room, and death. Further work expositing the pathophysiological mechanism of these associations may assist hand surgeons in preoperative optimization of these patients.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IIb.