Disparities in Delays to Lower Extremity Free Flap Reconstructions.

IF 1.4 4区 医学 Q3 SURGERY
Kristina L Khaw, Monica Morgenstern Berkman, Steven C Bonawitz
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引用次数: 0

Abstract

Background: Lower extremity flap reconstructions are often due to traumatic injuries requiring emergency surgeries. Studies found that delays to operating increase morbidity, mortality, and length of hospital stay. There are limited studies assessing disparities in delays to reconstruction. This study investigates factories correlated to delays in surgery in lower extremity reconstructions.

Methods: In a single center from January 2015 to January 2024, 80 patients who underwent a lower extremity flap reconstruction and remained inpatient until their reconstruction operation were identified. The time to surgery from admission, time to consult, and time from consult to surgery were collected. Delays to flap were defined as >14 days from admission to surgery. Demographics, substance use history, Charlson Comorbidity Index, and Trauma Severity Score were collected. A multiple analysis of variance for quantitative variables and a χ2 test for categorical variables were conducted. Variables with significant values on univariate analysis were further analyzed using a multivariate logistic regression to account for confounding variables.

Results: In the delay to flap (DF) cohort (n = 40) and no delay to flap (ND) cohort (n = 40), minority patients were more likely to experience delays to flap (P < 0.001). Surprisingly, there were no correlations to Charlson Comorbidity Index, Trauma Severity Score, marijuana, or illegal drug use. ND patients were more likely to have a history of tobacco use (P = 0.012). DF patients correlated with a significantly longer time to consult (DF: 8.1 d, ND: 2.3 d, P < 0.001) and time to surgery from consult (18.3 d, 5.8 d, P < 0.001). There was a significant correlation between DF and preoperative infection (P = 0.012). DF patients were significantly associated with hypertension (P = 0.030) and less likely to have gastroesophageal reflux disease (P = 0.032). Of significant factors, hypertension was significantly associated with complications (P = 0.037).

Conclusions: Patients who experience delays to flap were more likely to be a minority, have preoperative infections, delayed time to consult, and hypertension. Although postoperative infection was correlated with ND, DF patients were associated with preoperative infections. This suggests that there may be a disparity of infection management, susceptibility to infection, and flap recognition that lead to delays to lower extremity reconstruction. Larger prospective studies may be helpful to further evaluate reasons for delays.

下肢游离皮瓣重建延迟的差异。
背景:下肢皮瓣重建通常是由于创伤性损伤需要紧急手术。研究发现,手术延误会增加发病率、死亡率和住院时间。评估重建延误差异的研究有限。本研究探讨了与下肢重建手术延迟相关的工厂。方法:2015年1月至2024年1月,在同一中心对80例下肢皮瓣重建患者进行住院治疗,直至确定重建手术。收集患者入院至手术时间、会诊时间、会诊至手术时间。延迟皮瓣的定义为从入院到手术14天。统计数据、药物使用史、Charlson共病指数和创伤严重程度评分。定量变量采用多元方差分析,分类变量采用χ2检验。在单变量分析中具有显著值的变量使用多变量逻辑回归进一步分析,以解释混杂变量。结果:在延迟皮瓣移植(DF)组(n = 40)和不延迟皮瓣移植(ND)组(n = 40)中,少数患者更容易出现延迟皮瓣移植(P < 0.001)。令人惊讶的是,与查理森共病指数、创伤严重程度评分、大麻或非法药物使用没有相关性。ND患者有吸烟史的可能性更大(P = 0.012)。DF患者会诊时间(DF: 8.1 d, ND: 2.3 d, P < 0.001)和会诊至手术时间(DF: 18.3 d, 5.8 d, P < 0.001)显著相关。DF与术前感染有显著相关性(P = 0.012)。DF患者与高血压显著相关(P = 0.030),发生胃食管反流病的可能性较低(P = 0.032)。在显著因素中,高血压与并发症显著相关(P = 0.037)。结论:经历皮瓣延迟的患者更有可能是少数,术前感染,就诊时间延迟和高血压。虽然术后感染与ND相关,但DF患者与术前感染相关。这表明可能存在感染处理、感染易感性和皮瓣识别的差异,导致下肢重建延迟。更大规模的前瞻性研究可能有助于进一步评估延迟的原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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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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