Risk Factors Associated with Prolonged Postoperative Stay following Free Tissue Transfer

Background. No studies report robust data on the national incidence and risk factors associated with catastrophic medical outcomes following free tissue transfer. Methods. The American College of Surgeons (ACS) multicenter, prospective National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent free tissue transfer between 2006 and 2011. Multivariable logistic regression was used for statistical analysis. Results. Over the 6-year study period 2,349 patients in the NSQIP database underwent a free tissue transfer procedure. One hundred and twenty-two patients had at least one catastrophic medical outcome (5.2%). These 122 patients had 151 catastrophic medical outcomes, including 93 postoperative respiratory failure events (4.0%), 14 pulmonary emboli (0.6%), 13 septic shock events (0.5%), 12 myocardial infarctions (0.5%), 6 cardiac arrests (0.3%), 4 strokes (0.2%), 1 coma (0.0%), and 8 deaths (0.3%). Total length of hospital stay was on average 14.7 days longer for patients who suffered a catastrophic medical complication (P<0.001). Independent risk factors were identified. Conclusions. Free tissue transfer is a proven and safe technique. Catastrophic medical complications were infrequent but added significantly to length of hospital stay and patient morbidity.

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Clinical Factors Associated With Reoperation and Prolonged Length of Stay in Free Tissue Transfer to Oncologic Head and Neck Defects

JAMA Facial Plastic Surgery ◽

10.1001/jamafacial.2017.1771 ◽

2018 ◽

Vol 20 (2) ◽

pp. 154-159 ◽

Cited By ~ 16

Author(s):

William W. Thomas ◽

Jason Brant ◽

Jinbo Chen ◽

Orly Coblens ◽

John P. Fischer ◽

...

Keyword(s):

Length Of Stay ◽

Head And Neck ◽

Free Tissue Transfer ◽

Clinical Factors ◽

Prolonged Length ◽

Factors Associated ◽

Tissue Transfer

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A Nationwide Analysis of Early and Late Readmissions following Free Tissue Transfer for Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1702175 ◽

2020 ◽

Vol 36 (06) ◽

pp. 450-457 ◽

Cited By ~ 1

Author(s):

David Alejandro Magno-Padron ◽

Willem Collier ◽

Jaewhan Kim ◽

Jayant P. Agarwal ◽

Alvin C. Kwok

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Breast Reconstruction ◽

Cancer Patients ◽

Postoperative Period ◽

Readmission Rate ◽

Free Tissue Transfer ◽

Breast Cancer Patients ◽

Tissue Transfer ◽

History Of

Abstract Background Traditionally, surgical quality outcomes are assessed using a 30-day postoperative window. For breast cancer patients undergoing free tissue transfer for breast reconstruction, we sought to describe the distribution of and specific risk factors for early and late readmissions within a 0- to 90-day postoperative period. Patients and Methods The Nationwide Readmissions Database was used to conduct a retrospective cohort study. Breast cancer patients undergoing free tissue transfer for breast reconstruction were identified using International Classification of Diseases -9 diagnosis and procedure codes. Ninety-day readmissions related to infection or wound complications were identified. Univariable and multivariable logistic regression models were used to identify patient risk factors for readmissions that occurred early (0–30 days) and late (31–90 days) after their index procedure. Results In the weighted sample, we identified approximately 7,305 free flap breast reconstructions and a surgical wound-related readmission rate of 4.3% (n = 312): 65.4% of the readmissions occurred early while 34.6% occurred late after surgery. The mean days to readmission was 26, and 75% of all readmissions occurred within the first 36 days after surgery. Variables independently associated with readmissions during the 0- to 90-day postoperative period included: history of chronic obstructive pulmonary disease (p = 0.036), hypertension (p = 0.03), obesity (p ≤ 0.001), and history of smoking (p = 0.004). The variables independently associated with the early readmission period were the same as those identified for the 0- to 90-day postoperative period. The variables independently associated with late readmissions were different: history of depression (p = 0.001) and history of smoking (p = 0.001). Conclusion The conventional 30-day hospital readmission rate classically used as a quality metric is overlooking a significant portion of admissions after free flap-based breast reconstruction. Different variables were found to be associated with readmission in the early versus late cohorts. Interventions targeting these variables could decrease readmissions and their associated costs.

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Effects of Transfusion on Free Flap Survival: Searching for an Optimal Hemoglobin Threshold for Transfusion

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1648244 ◽

2018 ◽

Vol 34 (08) ◽

pp. 610-615 ◽

Cited By ~ 2

Author(s):

Min Ji Kim ◽

Kyong-Je Woo ◽

So Ra Kang ◽

Bo Young Park

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Free Flap ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Free Tissue Transfer ◽

Control Group ◽

Flap Failure ◽

Tissue Transfer ◽

The Impact

Background Microsurgical free tissue transfer is a popular technique nowadays. Because of its considerably exquisite procedure, various risk factors can affect surgical outcome. However, current key practices, especially those in blood transfusion, are in contention due to the lack of enough evidence. Therefore, the objective of this study was to investigate the impact of perioperative blood transfusion on microsurgical complication. Methods Data of a total of 168 patients who underwent microvascular free tissue transfer from 2013 through 2016 were retrospectively reviewed. Age, comorbidity, anatomical surgical site, preoperative and postoperative lowest hemoglobin (Hb) level, estimated blood volume loss, and final clinical flap outcome were compared between patients with and without transfusion treatment. Factors with a significance of p < 0.05 in univariate analysis were included in the multivariate logistic regression model to identify independent risk factors. Results Of 168 patients, 72 (43%) were in the transfusion group. Cross analysis statistics showed that flap failure in the transfusion group was 3.6 times higher (p = 0.018) than that in the control group. Multivariable analysis revealed that age (p = 0.083) and perioperative lowest Hb level (p = 0.021) remained as significant predictors of flap failure. Receiver-operating characteristic curve analysis showed that the appropriate lower limit of transfusion commencement of Hb was 8.75 g/dL (area under the curve: 0.721). Conclusion A transfusion during perioperative period of free flap did not increase its failure rate. Rather than appropriate transfusion strategy, perioperative lowest Hb level, and age were significant predictors of flap failure. Therefore, transfusion can be confidently used in patients who undergo free flap without any hesitation. Results of this study provide practical evidence of performing perioperative transfusion for free tissue transfer patients.

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