Postoperative vascular compromise after digital replantation or revascularization: timing, risk factors, and salvage outcomes in a single-center retrospective cohort.

BACKGROUND: Postoperative vascular compromise remains a clinically important threat after digital replantation or revascularization, but its timing, clinical presentation, risk factors, and post-compromise salvage profile are often less systematically reported than final survival. METHODS: We performed a single-center retrospective cohort study using digit-level records. The primary outcome was postoperative vascular compromise at the digit level. Compromise type, the operation-start-referenced interval to first documentation of compromise, recorded management components, and salvage success, defined as complete survival or partial survival with digit preservation and without secondary amputation, were summarized. Logistic regression with patient-cluster robust standard errors was used for the vascular-compromise model; salvage models were exploratory complete-case analyses. RESULTS: This single-center retrospective study enrolled 671 digits from 484 patients. Postoperative vascular compromise occurred in 128 of 671 digits (19.1%). Venous congestion was the most common presentation (71.9%), followed by arterial insufficiency (21.1%) and mixed compromise (7.0%). The median operation-start-referenced interval to first documentation of vascular compromise was 15.88 h (IQR, 8.03-34.52), and 112 of 128 events (87.5%) were first documented within 48 h after the recorded operation-start timestamp. In the parsimonious multivariable vascular-compromise model, complete amputation (OR, 2.853; 95% CI, 1.780-4.575), vein grafting (OR, 2.963; 95% CI, 1.615-5.437), and longer operative duration (OR per hour, 1.079; 95% CI, 1.010-1.152) were associated with higher odds of compromise, whereas a greater number of arterial anastomoses was associated with lower odds (OR, 0.526; 95% CI, 0.331-0.835). Among compromise digits, salvage success was achieved in 81 of 128 digits (63.3%). Any recorded thrombolysis was associated with lower odds of salvage success in an exploratory complete-case model (N = 84; OR, 0.243; 95% CI, 0.089-0.662), a finding likely affected by confounding by indication. CONCLUSIONS: In this single-center retrospective cohort, approximately one in five replanted or revascularized digits developed postoperative vascular compromise, most commonly venous congestion. Complete amputation, vein grafting, longer operative duration, and fewer arterial anastomoses were associated with compromise and may help identify digits requiring intensified early surveillance. Post-compromise treatment-outcome findings should be interpreted as exploratory associations rather than causal effects.