Which non-surgical factors have predictive value for early digit survival after replantation or revascularization? A one-center observational study

Background Early digit survival after replantation or revascularization may be associated with patient and injury characteristics. This study aimed to identify non-surgical factors associated with early digit survival following traumatic digit injuries. Methods This retrospective single-center observational study included patients treated for complete or subtotal digit amputations or extensive soft-tissue injuries between 2015 and 2025. The primary outcome was digit survival at hospital discharge. Associations were assessed using multivariable mixed-effects logistic regression with a patient-specific random intercept, adjusting for age, smoking status, injury mechanism, extent of vascular injury, and injury level. Sensitivity analyses excluded single-bundle injuries and separately included only complete amputations. Results Among 232 patients with 363 injured digits, replantation or revascularization was attempted in 217 digits. Overall, 155 digits survived (71.4%). Survival was 92.9% after single-bundle injuries, 81.5% after two-bundle injuries, and 53.2% after complete amputations. Extent of vascular injury was associated with survival in the adjusted model (global p = 0.026). Complete amputation was associated with lower odds of survival than single-bundle injury (OR 0.015, 95% CI 0.001–0.327; p = 0.008). This association persisted after excluding single-bundle injuries (OR 0.055, 95% CI 0.004–0.663; p = 0.022). No statistically significant adjusted associations were identified for injury mechanism, injury level, smoking, or age, either in the primary model or among complete amputations alone. Conclusions The extent of vascular injury was the only evaluated factor significantly associated with early digit survival in the adjusted model. Complete amputations had lower odds of survival than injuries retaining tissue continuity. These findings concern survival at hospital discharge and should not be extrapolated to long-term functional outcomes.