Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients

Hassan, Bashar; Koura, Abdulghani Abou; Makarem, Adham; Mosleh, Kamal Abi; Dimassi, Hani; Tamim, Hani; Ibrahim, Amir

doi:10.3389/fsurg.2023.1080143

Cited by 6 publications

(5 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Longer operating time was also identified as a predictor of complications for microsurgical flap reconstruction. 20 34 35 36 37 In a previous study by Wong et al on 639 patients who underwent microsurgical free flap reconstruction, those with longer operating times were twice as likely to develop flap failure. 36 In our study population, only one patient experienced flap failure following phalloplasty.…”

Section: Discussionmentioning

confidence: 99%

Complications Following Gender-Affirming Phalloplasty: A NSQIP Review

Hassan,

Brown,

Guo

et al. 2024

J Reconstr Microsurg Open

View full text Add to dashboard Cite

Background: Gender-affirming phalloplasty has a complication rate as high as 76.5%. This is the first study to determine the predictors of 30-day complications following phalloplasty using a national registry. Methods: The NSQIP database (2012-2021) was queried for transgender men and current procedural terminology codes pertaining to flap or microsurgery procedures to select for single and first stage phalloplasty cases. Included were patients with a total hospital stay ≥5 days and operating time >4 hours to select for primary phalloplasty cases. The primary outcome was incidence of major and minor complications, and the secondary outcome was indication for unplanned reoperation. Bivariate analysis and multivariate logistic regression were performed to determine significant predictors of complications. Results: Of 90 patients, n=18 (20.0%) developed at least one complication. The most common complication was unplanned reoperation (n=10, 11.1%) due to hematoma evacuation (n=3, 30.0% of reoperations, 3.3% of all patients). A total of n=43 (47.8%) underwent single stage phalloplasty, and n=47 (52.2%) underwent first stage phalloplasty. Compared to patients without complications, those with minor complications more likely to have had single stage phalloplasty (n=37 [45.1%], n=6 [75.0%]; P=0.145), but the association was not statistically significant. Longer operating time was associated with greater odds of major complications (adjusted odds ratio [aOR] 95% confidence interval [CI] 1.01 [1.002-1.018]). Patients who smoked within 1 year of surgery had 123 times the odds of 30-day minor complications (surgical site infection, urinary tract infection, wound dehiscence, pneumonia) compared to non-smokers (aOR [CI] 123.3 [1.4->100.0]). Conclusion: There were no significant differences.

show abstract

Section: Discussionmentioning

confidence: 99%

Complications Following Gender-Affirming Phalloplasty: A NSQIP Review

Hassan,

Brown,

Guo

et al. 2024

J Reconstr Microsurg Open

View full text Add to dashboard Cite

show abstract

“…Among patients undergoing free flap reconstruction for the head and neck, race was an independent predictor of increased risk for SSI. 20 Using multivariate analysis, other studies highlight male gender and Black/African American race as predictors of increased risk for sepsis after reconstructive surgeries. 19 Our cohort reaffirmed the racial inequities reported in previous reconstruction literature.…”

Section: Discussionmentioning

confidence: 99%

“…In Hassan et al, predictors of SSI after flap reconstruction were identified and stratified by anatomic site. Among patients undergoing free flap reconstruction for the head and neck, race was an independent predictor of increased risk for SSI 20 . Using multivariate analysis, other studies highlight male gender and Black/African American race as predictors of increased risk for sepsis after reconstructive surgeries 19 .…”

Section: Discussionmentioning

confidence: 99%

Race and Ethnicity Independently Predict Adverse Outcomes Following Head and Neck Autograft Surgery

Ferraro,

Ahmed,

Lee

et al. 2024

The Laryngoscope

View full text Add to dashboard Cite

ObjectiveThere is growing attention toward the implications of race and ethnicity on health disparities within otolaryngology. While race is an established predictor of adverse head and neck oncologic outcomes, there is paucity in the literature on studies employing national, multi‐institutional data to assess the impact of race and ethnicity on head and neck autograft surgery.MethodsUsing the National Surgical Quality Improvement Program (NSQIP) database, trends in 30 days outcomes were assessed. Patients with ICD‐10 codes for malignant head and neck neoplasms were isolated. Autograft surgeries were selected using Current Procedural Terminology (CPT) codes for free flap and pedicled flap reconstruction. Primary outcomes included surgical complications, reoperation, readmission, extended length of stay and operation time. Each binary categorical variable was compared to racial/ethnic identity via binary logistic regression.ResultsThe study cohort consisted of 2447 patients who underwent head and neck autograft surgery (80.71% free flap reconstruction and 19.39% pedicled flap reconstruction). Black patients had significantly higher odds of overall surgical complications (odds ratio [OR] 1.583, 95% confidence interval [CI] 1.091, 2.298, p = 0.016) with much higher odds of perioperative blood transfusions (OR 2.291, 95% CI 1.532, 3.426, p = <.001). Hispanic patients were more likely to undergo reoperation within 30 days after surgery and were more likely to be hospitalized for more than 30 days post‐operatively (OR 1.566, 95% CI 1.015, 2.418, p = 0.043 and OR 12.224, 95% CI 2.698, 55.377, p = 0.001, respectively).ConclusionsRace and ethnicity serve as independent predictors of complications in the post‐operative period following head and neck autograft surgery.Level of EvidenceIII Laryngoscope, 2024

show abstract

“…LASSO analysis was used to screen the variables in this study owing to various clinical variables in the patient data. Compared to other models established solely using logistic regression 2 , this optimised model is less complex and helps physicians develop personalised treatment plans to minimise the risk of SSI in patients undergoing gastrointestinal surgery. This study had some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Infection can involve the skin at the site of the incision (superficial incision SSI), underlying tissues and muscles (deep incision SSI) or spread further into organs and/or spaces between organs (organ/space SSI). SSIs are among the most common nosocomial infections, accounting for ~20% of all hospital-acquired infections 2 . As a serious postoperative complication, SSI can lead to prolonged hospital stay, delayed wound healing, impaired tissue repair and flap necrosis, resulting in graft failure 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Prediction models of surgical site infection after gastrointestinal surgery: a nationwide prospective cohort study

Yang,

Zhang,

Zhang

et al. 2023

International Journal of Surgery

View full text Add to dashboard Cite

Objective: This study aimed to construct and validat a clinical prediction model for Surgical site infection (SSI) risk 30 days after gastrointestinal surgery. Materials and methods: This multi-centre study involving 57 units conducted a 30-day postoperative follow-up of 17,353 patients who underwent gastrointestinal surgery at the unit from 1 March 2021 to 28 February 2022. We collected a series of hospitalisation data, including demographic data, preoperative preparation, intraoperative procedures, and postoperative care. The main outcome variable was SSI, defined according to the Centres for Disease Control and Prevention guidelines. This study used the least absolute shrinkage and selection operator (LASSO) algorithm to screen predictive variables and construct a prediction model. The receiver operating characteristic curve, calibration, and clinical decision curves were used to evaluate the prediction performance of the prediction model. Results: Overall, 17,353 patients were included in this study, and the incidence of SSI was 1.6%. The univariate analysis combined with LASSO analysis showed that 20 variables, namely, chronic liver disease, chronic kidney disease, steroid use, smoking history, C-reactive protein, blood urea nitrogen, creatinine, albumin, blood glucose, bowel preparation, surgical antibiotic prophylaxis, appendix surgery, colon surgery, approach, incision type, colostomy/ileostomy at the start of the surgery, colostomy/ileostomy at the end of the surgery, length of incision, surgical duration, and blood loss were identified as predictors of SSI occurrence (P<0.05). The area under the curve values of the model in the train and test groups were 0.7778 and 0.7868, respectively. The calibration curve and Hosmer–Lemeshow test results demonstrated that the model-predicted and actual risks were in good agreement, and the model forecast accuracy was high. Conclusions: The risk assessment system constructed in this study has good differentiation, calibration, and clinical benefits and can be used as a reference tool for predicting SSI risk in patients.

show abstract

Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients

Cited by 6 publications

References 35 publications

Complications Following Gender-Affirming Phalloplasty: A NSQIP Review

Complications Following Gender-Affirming Phalloplasty: A NSQIP Review

Race and Ethnicity Independently Predict Adverse Outcomes Following Head and Neck Autograft Surgery

Prediction models of surgical site infection after gastrointestinal surgery: a nationwide prospective cohort study

Contact Info

Product

Resources

About