Combined (endo-)vascular intervention and microsurgical lower extremity free flap reconstruction—A propensity score matching analysis in 5386 ACS-NSQIP patients

Haug, Valentin; Kadakia, Nikita; Kauke, Martin; Hundeshagen, Gabriel; Diehm, Yannick; Fischer, Sebastian; Hirche, Christoph; Kneser, Ulrich; Pomahač, Bohdan

doi:10.1016/j.bjps.2020.10.045

Cited by 9 publications

(10 citation statements)

References 46 publications

(48 reference statements)

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“…General limitations include the retrospective nature of the ACS-NSQIP database associated with inherent biases and confounders. Further, the accuracy and quality of the information entered depend on subjective assessment and practical knowledge [ 68 ]. The multi-institutional (and multi-surgeon) extent of the database has been suggested as a potential root of bias, as the quality may vary both within and between the participating institutions.…”

Section: Discussionmentioning

confidence: 99%

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

Knoedler

Baecher

Hoch

et al. 2023

JCM

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Background: Orthognathic surgery (OS) is a frequently performed procedure for the correction of dentofacial deformities and malocclusion. Research on OS is mostly limited to single-surgeon experience or single-institutional reports. We, therefore, retrospectively analyzed a multi-institutional database to investigate outcomes of OS and identify risk factors for peri- and postoperative complications. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008–2020) to identify patients who underwent OS for mandibular and maxillary hypo- and hyperplasia. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. We also evaluated risk factors for complications. Results: The study population included 674 patients, 48% of whom underwent single jaw surgery, 40% double jaw surgery, and 5.5% triple jaw surgery. The average age was 29 ± 11 years, with an equal gender distribution (females: n = 336; 50%, males: n = 338; 50%). Adverse events were relatively rare, with a total of 29 (4.3%) complications reported. The most common surgical complication was superficial incisional infection (n = 14; 2.1%). While the multivariable analysis revealed isolated single lower jaw surgery (p = 0.03) to be independently associated with surgical complication occurrence, it also identified an association between the outpatient setting and the frequency of surgical complications (p = 0.03) and readmissions (p = 0.02). In addition, Asian ethnicity was identified as a risk factor for bleeding (p = 0.003) and readmission (p = 0.0009). Conclusion: Based on the information recorded by the ACS-NSQIP database, our analysis underscored the positive (short-term) safety profile of OS. We found OS of the mandible to be associated with higher complication rates. The calculated risk role of OS in the outpatient setting warrants further investigation. A significant correlation between Asian OS patients and postoperative adverse events was found. Implementation of these novel risk factors into the surgical workflow may help facial surgeons refine their patient selection and improve patient outcomes. Future studies are needed to investigate the causal relationships of the observed statistical correlations.

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Section: Discussionmentioning

confidence: 99%

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

Knoedler

Baecher

Hoch

et al. 2023

JCM

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“…Although there was variability between studies, as reoperation involves revascularization-related complications; for example, the reoperation rate was as high as 63% in the study by Tukiainen et al In a matched-pair analysis, Haug et al found that this combined procedure had a significantly higher reoperation rate than free flap reconstruction only in the lower extremities. 22 This may be a natural result of higher reoperation rates, as it includes reoperations for flap-related complications as well as revascularization-related complications. Another meta-analysis focusing on venous anastomosis for free flap reconstruction in the lower extremity indicated rates of vascular thrombosis of 5 to 9%, total flap failure of 5 to 6%, and partial flap failure of 5 to 7%.…”

Section: Discussionmentioning

confidence: 99%

“…Although the article reported by Hsu et al 9 was from the same institution as the included article reported by Chang et al 6 and had overlapping study periods, only data of free flaps combined with bypass surgery were extracted from the article reported by Hsu et al The 15 articles encompassing 1,176 patients with 1,194 free flaps were ultimately included in the qualitative and quantitative assessment (Figure 1). 6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22] The study design for all included articles was a retrospective cohort study. The risk of bias in the included articles was assessed using the ROBINS-I tool.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Combined Revascularization and Free Flap Reconstruction for Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis

Shimbo

Kawamoto

Koshima

2022

J Reconstr Microsurg

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Background Combined revascularization and free flap reconstruction is one treatment method for chronic limb-threatening ischemia (CLTI) with complex wounds. The purpose of this systematic review and meta-analysis was to investigate the characteristics of this combined procedure and to assess postoperative outcomes. Methods A systematic search was performed across PubMed, Scopus, and the Web of Science for studies between January 2000 and February 2022. A random-effects meta-analysis for postoperative outcome was conducted. Results Fifteen articles encompassing 1,176 patients with 1,194 free flaps were ultimately included in the qualitative and quantitative assessment. Our meta-analysis showed the following complication rates for short-term postoperative outcomes: 37% (95% CI, 18%–53%; I2 = 74%) for reoperation, 13% (95% CI, 2%–24%; I2 = 0%) for vascular thrombosis, 9% (95% CI, 0%–17%; I2 = 0%) for total flap failure, 8% (95% CI, 0%–17%; I2 = 0%) for partial flap failure, 4% (95% CI, 0%–10%; I2 = 0%) for amputation, and 3% (95% CI, 0%–9%; I2 = 0%) for 30-day mortality. The 1-, 3-, and 5-year limb salvage rates were 86% (95% CI, 78%–92%), 81% (95% CI, 68%–88%), and 71% (95% CI, 53%–83%), respectively. The 1-, 3-, and 5-year patient survival rates were 93% (95% CI, 90%–96%), 92% (95% CI, 77%–97%), and 75% (95% CI, 50%–88%), respectively. Conclusion Combined revascularization and free flap reconstruction for CLTI with complex wounds was clearly effective for the long-term outcomes. However, this combined procedure should be considered on the assumption that the reoperation rate is high and that flap-related complications rate may be higher than lower extremity reconstruction of other etiologies.

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“…Per prior methodology, Current Procedural Terminology (CPT) codes were used to identify patients who underwent LE open vascular procedures (Supplemental Table 1). 7 In a secondary analysis, patients who underwent LE open vascular procedure were also identified by the 2011-2020 Vascular Procedure Targeted Lower Extremity Open (LEO) Participant Use Data This article is protected by copyright. All rights reserved.…”

Section: Data Source and Patient Selectionmentioning

confidence: 99%

Pedicled Flaps for High-Risk Open Vascular Procedures of the Lower Extremity: An Analysis of The National Surgical Quality Improvement Project Database

Garvey,

Valentine,

Weidman

et al. 2023

J Reconstr Microsurg

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Background: Use of pedicled flaps in vascular procedures is associated with decreased infection and wound breakdown. We evaluated the risk profile and postoperative complications associated with lower extremity open vascular procedures with and without pedicled flaps. Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2010–2020) was queried for CPT codes representing lower extremity open vascular procedures, including trunk and lower extremity pedicled flaps. Flap patients were compared to a randomized control group without flaps (1:3 cases to controls). Univariate and multivariate analyses were performed. Results: We identified 132,934 adults who underwent lower extremity open vascular procedures. Concurrent pedicled flaps were rare (0.7%), and patients undergoing bypass procedures were more likely to receive a flap than non-bypass patients (69% vs 64%, p<0.0001). Flap patients had greater comorbidities. On univariate analysis, flap patients were more likely to experience wound (p=0.0026), mild systemic (p<0.0001), severe systemic (p=0.0452), and all-cause complications (p<0.0001). After adjusting for factors clinically suspected to be associated with increased risk (gender, body mass index, procedure type, American Society of Anesthesiologists classification, functional status, diabetes, smoking, and albumin < 3.5 mg/dL), wound (p=0.096) and severe systemic complications (p=0.0719) were no longer significantly associated with flap patients. Conclusion: Lower extremity vascular procedures are associated with a high risk of complications. Use of pedicled flaps remains uncommon and more often performed in patients with greater comorbid disease. However, after risk adjustment, use of a pedicled flap in high-risk patients may be associated with lower than expected wound and severe systemic complications.

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Combined (endo-)vascular intervention and microsurgical lower extremity free flap reconstruction—A propensity score matching analysis in 5386 ACS-NSQIP patients

Cited by 9 publications

References 46 publications

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

Early Outcomes and Risk Factors in Orthognathic Surgery for Mandibular and Maxillary Hypo- and Hyperplasia: A 13-Year Analysis of a Multi-Institutional Database

Combined Revascularization and Free Flap Reconstruction for Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis

Pedicled Flaps for High-Risk Open Vascular Procedures of the Lower Extremity: An Analysis of The National Surgical Quality Improvement Project Database

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