Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.

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Free Flap Versus Pedicled Flap Reconstruction of Laryngopharyngeal Defects: A 10-Year National Surgical Quality Improvement Program Analysis

The Laryngoscope ◽

10.1002/lary.27455 ◽

2018 ◽

Vol 129 (1) ◽

pp. 105-112 ◽

Cited By ~ 4

Author(s):

Yarah M. Haidar ◽

Edward C. Kuan ◽

Sunil P. Verma ◽

Julie A. Goddard ◽

William B. Armstrong ◽

...

Keyword(s):

Quality Improvement ◽

Free Flap ◽

Program Analysis ◽

Pedicled Flap ◽

Quality Improvement Program ◽

Flap Reconstruction ◽

Improvement Program ◽

Surgical Quality

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Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: Evaluation of the National Surgical Quality Improvement Program data

Breast Diseases A Year Book Quarterly ◽

10.1016/j.breastdis.2015.04.006 ◽

2015 ◽

Vol 26 (2) ◽

pp. 159

Author(s):

P. Weisman ◽

H.Y. Wen

Keyword(s):

Breast Cancer ◽

Quality Improvement ◽

Frozen Section ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality ◽

Reoperation Rates ◽

Program Data

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Comparing Plastic Surgeon Versus Orthopedic Surgeon Outcomes Following Distal Upper Extremity Amputations: A Study of the National Surgical Quality Improvement Program (NSQIP) Database

Plastic Surgery ◽

10.1177/2292550320947834 ◽

2020 ◽

pp. 229255032094783

Author(s):

Jerry Y. Du ◽

Joanne H. Wang ◽

Cristin L. Coquillard ◽

Anand R. Kumar ◽

Kevin J. Malone

Keyword(s):

Quality Improvement ◽

Upper Extremity ◽

Perioperative Complications ◽

Univariate Analysis ◽

Wound Dehiscence ◽

Quality Improvement Program ◽

Perioperative Outcomes ◽

Improvement Program ◽

Surgical Quality ◽

Orthopedic Surgeons

Background: Both plastic and orthopedic surgeons manage care for urgent/emergent hand conditions. It is unclear if surgeon specialty affects patient outcomes of these cases. The purpose of this study was to evaluate differences in 30-day perioperative outcomes between plastic and orthopedic surgeons following distal upper extremity amputations. Methods: Patients who underwent distal upper extremity amputations between 2005 and 2016 were identified within the National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology ( CPT) codes. Differences in operative procedures, patient demographics, patient comorbidities, and 30-day perioperative complications were compared between orthopedic and plastic surgeons by univariate analysis. A Bonferroni correction was applied to account for multiple comparisons of complications. Results: A total of 1583 cases met inclusion criteria. Orthopedic surgeons performed 981 cases (62.0%) and plastic surgeons performed 602 cases (38.0%). Finger amputations comprised the majority of procedures for both orthopedic and plastic surgeons (95.5% and 94.4%, respectively). Orthopedic surgeons had a lower operative time (41.7 ± 36.2 minutes vs 47.1 ± 40.9 minutes, P = .008). There were no differences in proportion of emergency surgery, inpatients, or wound class. There were no differences in age, gender, or body mass index. The most common indications for amputation were trauma, gangrene, and osteomyelitis. There were no differences between surgical specialties in 18 30-day perioperative complications assessed, including death, reoperation, surgical site infection, or wound dehiscence. Conclusions: Plastic and orthopedic surgeons achieved equivalent outcomes comparing 30-day perioperative complications following upper extremity amputations. These results support that both orthopedic and plastic surgeons provide similar quality distal upper extremity amputation care.

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Recent Smoking History Is Not Associated With Adverse 30-Day Standardized Postoperative Outcomes Following Microsurgical Reconstructive Procedures of the Upper Extremity: Un Antécédent de Tabagisme Récent n’est Pas Associé à des Événements Indésirables Postopératoires Standardisés 30 Jours après des Procédures Microchirurgicales de Reconstruction du Membre Supérieur

Plastic Surgery ◽

10.1177/22925503211024755 ◽

2021 ◽

pp. 229255032110247

Author(s):

Olachi O. Oleru ◽

Neil V. Shah ◽

Peter L. Zhou ◽

Dillon Sedaghatpour ◽

Jaydev B. Mistry ◽

...

Keyword(s):

Wound Healing ◽

Upper Extremity ◽

Free Flap ◽

Postoperative Outcomes ◽

Smoking History ◽

Improvement Program ◽

Reconstructive Procedures ◽

Microsurgical Reconstruction ◽

Flap Transfer ◽

Free Flap Transfer

Background: Upper extremity (UE) microsurgical reconstruction relies upon proper wound healing for optimal outcomes. Cigarette smoking is associated with wound healing complications, yet conclusions vary regarding impact on microsurgical outcomes (replantation, revascularization, and free tissue transfer). We investigated how smoking impacted 30-day standardized postoperative outcomes following UE microsurgical reconstruction. Methods: Utilizing the National Surgical Quality Improvement Program, all patients who underwent (1) UE free flap transfer (n = 70) and (2) replantation/revascularization (n = 270) were identified. For each procedure, patients were stratified by recent smoking history (current smoker ≤1-year preoperatively). Baseline demographics and standardized 30-day complications, reoperations, and readmissions were compared between smokers and nonsmokers. Results: Replantation/revascularization patients had no differences in sex, race, or body mass index between smokers (n = 77) and nonsmokers. Smokers had a higher prevalence of congestive heart failure (5.2% vs 1.0%, P = .036) and nonsmokers were more often on hemodialysis (15.6% vs 10.4%, P = .030). Free flap transfer patients had no differences in age, sex, or race between smokers (n = 14) and nonsmokers. Smokers had a longer length of stay (6.6 vs 4.2 days, P = .001) and a greater prevalence of chronic obstructive pulmonary disorder (COPD; 7.1% vs 0%, P = .044). Recent smoking was not associated with increased odds of any 30-day minor and major standardized surgical complications, readmissions, or reoperations following UE microsurgical reconstruction via free flap transfer or replantation/revascularization. Baseline diagnosis of COPD was also not a predictor of adverse 30-day outcomes following free flap transfer. Conclusion: Recent smoking history was not associated with any 30-day adverse outcomes following UE microsurgical reconstruction via replantation/revascularization or free flap transfer. In light of these findings, further investigation is warranted, with particular focus on adverse events specific to free flaps and replantation/revascularization.

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