The Modified Fragility Index and Perioperative Albumin as Predictors of Complications in Complex Abdominal Wall Reconstruction.

IF 1.4 4区 医学 Q3 SURGERY
Annals of Plastic Surgery Pub Date : 2025-04-01 Epub Date: 2025-02-19 DOI:10.1097/SAP.0000000000004316
Makenna Ash, Troy Marxen, Shannon Su, Albert Losken
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引用次数: 0

Abstract

Background and significance: Complex abdominal wall reconstruction (CAWR) is performed to restore the structure and function of the abdominal wall. These procedures carry the risk of complications such as delayed wound healing, skin necrosis, infection, recurrence, or even death. The 5-factor modified fragility index (5-mFI) has gained popularity as a concise method of evaluating preoperative risk across various surgical specialties. Additionally, perioperative hypoalbuminemia has been previously associated with delayed wound healing after surgery. The purpose of this study was to assess the utility of the 5-mFI in combination with perioperative albumin levels for assessing risk in complex abdominal wall reconstruction.

Methods: This was a retrospective, single-institution chart review study of all patients who underwent CAWR by the senior author (A.L.) from 2002 to 2023. Demographics, comorbidities, details of surgery, perioperative albumin levels, ASA scores, and complications were collected for each patient. Five-factor modified fragility indices were calculated for each patient. Statistical analysis consisted of χ 2 and Fisher exact tests for categorical variables, t tests for continuous variables, and multivariate analysis.

Results: Our analysis included 437 patients. The average age of our patients was 54.3 years, the average BMI was 32.1 kg/m 2 , and the average length of follow-up with the plastic surgery service was 264 days. A total of 118 (27.0%) developed complications, with the most common complications being delayed wound healing (89 patients, 20.4%) and infection (78 patients, 17.8%). Other complications included skin necrosis, fistula formation, hematoma, seroma, infection, and death. Sixty patients (13.7%) experienced recurrence of their hernias within the follow-up period. An mFI of 2 or greater was significantly associated with delayed wound healing (LR, 11.42; P = 0.0436) as well as skin necrosis (LR, 4.826; P = 0.028). The presence of an mFI of 2 or greater and perioperative hypoalbuminemia was significantly associated with development of major complications (LR, 3.221; P = 0.0457), delayed wound healing (LR, 5.999; P = 0.0143), skin necrosis (LR, 9.19; P = 0.0024), and mortality (LR, 5.287; P = 0.0215). On multivariate analysis, the presence of an mFI of 2 or greater when combined with perioperative hypoalbuminemia was found to be independently associated with mortality (LR, 1524.5; P < 0.0001).

Conclusions: We found the 5-factor mFI to be significantly associated with delayed wound healing and skin necrosis in our patient population. When an mFI of 2 or greater was present along with perioperative hypoalbuminemia, patients were significantly more likely to experience complications, issues with wound healing, and mortality. Surgeons should take these findings into account when counseling patients preoperatively.

改良脆性指数和围手术期白蛋白作为复杂腹壁重建并发症的预测指标。
背景与意义:复杂腹壁重造术(Complex腹壁重造术,CAWR)是一种恢复腹壁结构和功能的手术。这些手术有并发症的风险,如伤口愈合延迟、皮肤坏死、感染、复发,甚至死亡。5因子修正脆弱性指数(5-mFI)作为一种评估各种外科专科术前风险的简明方法已得到普及。此外,围手术期低白蛋白血症与手术后伤口愈合延迟有关。本研究的目的是评估5-mFI结合围手术期白蛋白水平评估复杂腹壁重建风险的效用。方法:这是一项回顾性的单机构图表回顾研究,由资深作者(A.L.)从2002年到2023年接受了car的所有患者。收集每位患者的人口统计学、合并症、手术细节、围手术期白蛋白水平、ASA评分和并发症。计算每位患者的五因素修正脆弱性指数。统计分析包括分类变量的χ2和Fisher精确检验,连续变量的t检验和多变量分析。结果:我们的分析包括437例患者。患者平均年龄54.3岁,平均BMI为32.1 kg/m2,平均随访时间为264天。共有118例(27.0%)出现并发症,其中最常见的并发症是伤口延迟愈合(89例,20.4%)和感染(78例,17.8%)。其他并发症包括皮肤坏死、瘘管形成、血肿、血肿、感染和死亡。60例(13.7%)患者在随访期间出现疝气复发。mFI为2或更高与伤口愈合延迟显著相关(LR, 11.42;P = 0.0436)和皮肤坏死(LR, 4.826;P = 0.028)。mFI≥2和围手术期低白蛋白血症与主要并发症的发生显著相关(LR, 3.221;P = 0.0457),伤口愈合延迟(LR, 5.999;P = 0.0143),皮肤坏死(LR, 9.19;P = 0.0024),死亡率(LR, 5.287;P = 0.0215)。多变量分析发现,mFI≥2合并围手术期低白蛋白血症与死亡率独立相关(LR, 1524.5;P < 0.0001)。结论:我们发现在我们的患者群体中,5因素mFI与伤口愈合延迟和皮肤坏死显著相关。当mFI大于等于2并伴有围手术期低白蛋白血症时,患者更容易出现并发症、伤口愈合问题和死亡率。外科医生在术前咨询患者时应考虑到这些发现。
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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
584
审稿时长
6 months
期刊介绍: The only independent journal devoted to general plastic and reconstructive surgery, Annals of Plastic Surgery serves as a forum for current scientific and clinical advances in the field and a sounding board for ideas and perspectives on its future. The journal publishes peer-reviewed original articles, brief communications, case reports, and notes in all areas of interest to the practicing plastic surgeon. There are also historical and current reviews, descriptions of surgical technique, and lively editorials and letters to the editor.
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