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Wound Complications and Reoperation Following Lower Extremity Reconstruction and Surgical Indications: A NSQIP Database Study
Clara E. Tandar
*, Margaret R. Wang, Ali Mansour, Nikhil Sobti, Reena Bhatt
Department of Plastic Surgery, Brown University, Providence, RI
Introduction: This study characterizes surgical indications and rates of complications and re-operation within 30 days following lower extremity (LE) pedicled flap surgery using a national database.
Methods: The National Surgical Quality Improvement Program (NSQIP) database (2005-2022) was reviewed to identify patients who underwent LE "pedicled axial" flap reconstruction (CPT 15738). Cases were classified into categories by ICD-9/10 codes: cancer/neoplasm, trauma/open wound, illness (e.g. infection, pressure ulcers), post-operative complications (e.g. hardware/surgical site infection), and other indications. Cases unrelated to the pelvis or LE were excluded. Outcome variables were postoperative complications, defined as re-operation or wound complications including surgical site infections (SSIs) and dehiscence within 30 days of surgery. Bivariate and multivariate analyses assessed the association of predictor and outcome variables.
Results: Of 880 patients, the most common indication was neoplasm/cancer (n=442, 50.2%), followed by trauma/open wounds (n=223, 25.3%), infection/pressure ulcers (n=157, 17.2%) and post-operative complications (n=37, 4.2%). 18.0% (n=158) of patients experienced postoperative wound complications (n=123, 14.0%) and/or required reoperation (n=64, 7.3%). Binary logistic regression analysis adjusted for age and diabetes demonstrated that increased operation time (aOR 1.003, 1.001-1.004, p=0.001) and disseminated cancer (aOR 5.1, 95% CI 2.5 - 10.5, p<0.001) were significantly associated with complications including reoperation. Furthermore, a surgical indication was a significant predictor of wound complications excluding reoperation (p=0.016), with cancer/neoplasm associated with a 2.5 higher odds compared to illness-related indications (aOR=2.5, 95% CI 1.2-5.1, p=0.013)
Conclusion:Lower extremity flap reconstructions for neoplastic indications may be more likely to be associated with postoperative wound complications. Patients with disseminated cancer may be more likely to experience complications including reoperation.
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