Kylie Swiekatowski, Jose Barrera, David Hopkins, Arvind Manisundaram, Mohin A Bhadkamkar, Yuewei Wu-Fienberg
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引用次数: 0
Abstract
Background: The rising clinical importance of assessing frailty is driven by its predictive capability for postoperative outcomes. This study assesses RAI-rev (Risk Analysis Index) effectiveness in predicting adverse outcomes in lower extremity (LE) flap reconstruction.
Methods: Analyzing NSQIP data from 2015-2020, we compared demographics, perioperative factors, and 30-day outcomes in all locoregional and free flap cases. Frailty scores, calculated using RAI-rev, were categorized with <15 as non-frail and >35 as the most frail. Adjusted odds-ratios (aOR) for specific complications were calculated using non-frail as the reference group. Frailty scores in locoregional flaps were compared to those in free flaps.
Results: We identified 270 locoregional and 107 free flap cases. Higher RAI-rev scores in locoregional flaps correlated with increased complications, such as deep surgical site infection (1% non-frail vs. 20% RAI 31-35), stroke (0% non-frail vs. 17% most-frail), and mortality (0% non-frail vs. 17% most-frail). Locoregional flap cases with RAI-rev scores in the most-frail group had a significantly elevated aOR for stroke (51.0, 95% CI: 1.8-1402.5, p=0.02), mortality (43.1, 95% CI: 1.6-1167.6, p=0.03), and any complication (6.8, 95% CI: 1.2-37.4, p=0.03). In free flap cases, higher RAI-rev scores were associated with increased complications, with only sepsis showing a statistically significant difference (6% non-frail vs. 100% most-frail; aOR 42.3, CI: 1.45 - 1245.3, p=0.03). Free flap cases had a significantly lower RAI-rev score compared to locoregional flap cases (14.91 vs. 17.64, p=0.01).
Conclusion: Elevated RAI-rev scores (>35) correlated with more complications in locoregional flaps, while free flap reconstruction patients had generally low RAI-rev scores. This suggests that free flaps are less commonly recommended for presumed higher-risk patients. The study demonstrates that RAI-rev may be able to serve as a risk calculator in lower extremity reconstruction, aiding in the assessment of candidates for limb salvage versus amputation.
期刊介绍:
The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers.
The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases.
The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.