Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Yu, Jihion; Hong, Joon Pio; Suh, Hyunsuk Peter; Park, Jun-Young; Kim, Doo-Hwan; Ha, Sangwoo; Hwang, Jai‐Hyun; Kim, Young‐Kug

doi:10.3390/nu12020562

Cited by 23 publications

(28 citation statements)

References 45 publications

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“…Prognostic nutritional index (PNI) is based on the patient’s serum albumin level and total lymphocyte count and has been proposed as a method of assessing the perioperative nutritional status, complications and mortality in patients with colorectal cancer [ 10 ]. Low PNI is associated with poor outcomes in patients with malignancy [ 10–14 ], free flap reconstruction [ 15 ], heart failure [ 16 , 17 ] and kidney transplantation [ 18 ]. However, to our knowledge, no study has evaluated the association between perioperative PNI and postoperative mortality in elderly burn patients.…”

Section: Introductionmentioning

confidence: 99%

The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients

Seo

Kong

et al. 2021

Burns &Amp; Trauma

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Background Burn injury in elderly patients can result in poor outcomes. Prognostic nutritional index (PNI) can predict the perioperative nutritional status and postoperative outcomes. We aim to evaluate the risk factors, including PNI, for one-year mortality after burn surgery in elderly patients. Methods Burn patients aged ≥65 years were retrospectively included. PNI was calculated using the following equation: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm3). Cox regression, receiver operating characteristic curve and Kaplan–Meier survival analyses were performed to evaluate the risk factors for postoperative one-year mortality. Results Postoperative one-year mortality occurred in 71 (37.6%) of the 189 elderly burn patients. Risk factors for one-year mortality were PNI on postoperative day one (hazard ratio (HR) = 0.872; 95% CI = 0.812–0.936; p < 0.001), Sequential Organ Failure Assessment score (HR = 1.112; 95% CI = 1.005–1.230; p = 0.040), American Society of Anesthesiologists physical status (HR = 2.064; 95% CI = 1.211–3.517; p = 0.008), total body surface area burned (HR = 1.017; 95% CI = 1.003–1.032; p = 0.015) and preoperative serum creatinine level (HR = 1.386; 95% CI = 1.058–1.816; p = 0.018). The area under the curve of PNI for predicting one-year mortality after burn surgery was 0.774 (optimal cut-off value = 25.5). Patients with PNI ≤25.5 had a significantly lower one-year survival rate than those with PNI >25.5 (32.1% vs 75.9%, p < 0.001). Conclusions PNI on postoperative day one was associated with postoperative one-year mortality in elderly burn patients. The postoperative one-year survival rate was lower in patients with PNI ≤25.5 than in those with PNI >25.5. These findings indicate the importance of identifying elderly burn patients with low PNI, thereby reducing the mortality after burn surgery.

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Section: Introductionmentioning

confidence: 99%

The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients

Seo

Kong

et al. 2021

Burns &Amp; Trauma

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“…Women may have a smaller vascular diameter than men so that anastomoses will be more difficult. [21] In this study, there was no difference in the risk of flap failure between men and women. These results are similar to free-style flaps meta-analysis.…”

Section: Agementioning

confidence: 51%

A Meta-Analysis Study: Risk Factors of Total Flap Necrosis in Microsurgery

Sastri¹,

Rizaliyana²,

Nata'atmadja³

2023

IJRP

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Background:Free flap surgery allows closure of the defect with excellent results. Developed knowledge and skills lead to higher success rates. Failure to do so in the form of total flap necrosis can cause burdensome problems for both the surgeon and the patient. We performed a meta-analysis to analyze several risk factors for total flap necrosis in free flap surgery. Age, gender, diabetes mellitus (DM), hypertension (HT), duration of surgery, blood transfusions, and intraoperative intravenous fluids are among them. Methods:This study was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. We used the PubMed, Science Direct, Proquest, and Web of Science databases from January 2019 to December 2020. The selected articles described free flaps and included the number of cases according to variables and the incidence of total flap necrosis. Results:We found thirteen articles met the criteria for meta-analysis. A total of 2,063 free flaps were documented, and 65.9% were male patients. Most of the defects were caused by malignancies (75.4%). The most common location was the head and neck (72.7%). Free flaps from the lateral circumflex femoral system and the radial forearm are the two most common types of free flaps. The overall success of the free flap in this study was 93.45%, while the failure rate was 6.55%. Total necrosis was found in 23% of all postoperative complications. There were no significant differences in criteria for old age (> 60 years), female gender, DM, HT, and duration of surgery. Transfusions or intraoperative fluid administration cannot be concluded from this research. Conclusion:The causes of free flap failure are multifactorial and no absolute contraindications to surgery are mentioned in the literature. Some of the factors analyzed in this study were not significant as the risk of total free flap necrosis but could lead to other surgical or medical complications. However, further studies are needed.

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“…The main indicator of the patient's protein status is the serum albumin level (10,11). Prognostic nutritional index calculated by serum albumin and lymphocyte is a useful biomarker for postoperative complications and systemic inflammation (12). PNI value has been shown to be an independent prognostic factor for predicting postoperative complications and survival in patients undergoing different tumor surgeries (13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Morbidity in Children With Cerebral Palsy Sequelae Who Underwent Corrective Osteotomy

Canbolat¹

2022

J Istanb Fac Med

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Objective: Cerebral palsy (CP) is a neurodevelopmental disease characterized by movement and posture disorders due to non-progressive damage. Femur varization-derotation osteotomy is a surgical procedure performed to correct femoral anteversion in patients with CP. The aim of this study is to determine the factors affecting morbidity in children with CP sequelae who underwent corrective osteotomy.

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Prognostic Nutritional Index is a Predictor of Free Flap Failure in Extremity Reconstruction

Cited by 23 publications

References 45 publications

The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients

The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients

A Meta-Analysis Study: Risk Factors of Total Flap Necrosis in Microsurgery

Factors Affecting Morbidity in Children With Cerebral Palsy Sequelae Who Underwent Corrective Osteotomy

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