Northeastern Society of Plastic Surgeons

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Predictors and Outcomes of Repeated Unplanned Reoperations After Free Tissue Transfer
Christina Bear*, Dylan K. Kim, Christine H. Rohde
Columbia University, Nyc, NY

Background: Free tissue transfers (FTT) often carry significant postoperative complication risks, including one or more reoperations. This study investigates the prevalence, timing, and demographic and clinical predictors of such outcomes. Methods: The 2013-2022 National Surgical Quality Improvement Program database was queried for FTT operations via CPT codes. Occurrences of ≥1 unplanned reoperations (UR) were characterized by indication and timing after principal operative procedure (POP). Further, multivariate logistic regression was performed to identify reoperation predictors (p<0.05). Results: Of 23,889 FTT patients who met inclusion criteria, the most common reconstruction areas were breast (64%) and head/neck (17.5%). 3,040 (12.7%) patients had one UR, 663 (2.7%) had two UR, and 162 (0.7%) had ≥2 UR. The 30-day mortality rate increased from 0.3% in patients with zero UR to 1.2% in those with ≥2 UR. Head/neck reconstruction had the highest rates of initial reoperation (16.7%) and second reoperation (4.0%). The most common indication for initial UR in head/neck was vascular repair/reanastomosis (31.2%), which also conferred higher risk for subsequent UR in all regions (p<0.001). Overall, patients with two UR had a significantly earlier initial reoperation on average (4.9±6.1d post-POP) compared to those with only one UR (8.8±9.1d) (p<0.001).The most significant predictors of first UR included hypertension, ASA class >2, inpatient setting, smoking history, immunosuppressive therapy, longer operative time, higher BMI, breast procedure, and longer length of stay (LOS) (p<0.001). For second UR, significant predictors were longer operative time, higher BMI, and longer LOS (p<0.001). Conclusions: Prevalence of multiple reoperations in FTT and associated mortality rates is significant. Alongside well-studied factors like comorbidities, specific reconstruction regions, initial UR indication, and earlier timing for first UR may indicate higher risk for subsequent reoperation, informing postoperative risk assessment, especially in the first week after initial surgery.


Figure 1. Days between first and second reoperation for patients who experienced at least two reoperations, depending on indication for initial reoperation.
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