Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction

被引:1
作者
Deldar, Romina [1 ]
Huffman, Samuel S. [2 ]
Bovill, John D. [2 ]
Gupta, Nisha [2 ]
Truong, Brian N. [2 ]
Haffner, Zoe K. [1 ]
Sayyed, Adaah A. [1 ]
Fan, Kenneth L. [1 ]
Evans, Karen K. [1 ,3 ]
机构
[1] MedStar Georgetown Univ Hosp, Dept Plast & Reconstruct Surg, Washington, DC USA
[2] Georgetown Univ, Sch Med, Washington, DC USA
[3] Georgetown Univ Hosp, 3800 Reservoir Rd NW, Washington, DC 20007 USA
关键词
FREE-TISSUE TRANSFER; PROLONGED HOSPITAL STAY; AMERICAN-COLLEGE; MUSCLE FLAPS; OLDER-ADULTS; RISK-FACTORS; COMPLICATIONS; HEAD; MORTALITY; DEFECTS;
D O I
10.1002/micr.31135
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Identifying at-risk patients for complications remains challenging in patients with chronic lower extremity (LE) wounds receiving free tissue transfer (FTT) for limb salvage. The modified-5 frailty index (mFI-5) has been utilized to predict postoperative complications, yet it has not been studied in this population. The aim of this study was to determine the utility of the mFI-5 in predicting adverse postoperative outcomes.Methods: Patients >= 60 years, who underwent LE FTT reconstruction at a single institution from 2011 to 2022, were retrospectively reviewed. Patient characteristics, mFI-5, and postoperative outcomes were collected. Cohorts were divided by an mFI-5 score of <2 or >= 2.Results: A total of 115 patients were identified, of which 71.3% (n = 82) were male, 64.3% (n = 74) had a mFI-5 score of >= 2, and 35.7% (n = 41) had a score <2. The average age and body mass index were 67.8 years and 28.7 kg/m(2) , respectively. The higher mFI-5 cohort had lower baseline albumin levels (3.0 vs. 4.0 g/dL, p = .015) and higher hemoglobin A1c levels (7.4 vs. 5.8%, p < .001). The postoperative length of stay was longer in the higher mFI-5 cohort (18 vs. 13.4 days, p = .003). The overall flap success was 96.5% (n = 111), with no difference between cohorts (p = .129). Postoperative complications were comparable between cohorts (p = .294). At a mean follow-up of 19.8 months, eight patients (7.0%) underwent amputation, and 91.3% (n = 105) were ambulatory.Conclusion: High microsurgical success rates can be achieved in comorbid patients with high frailty indexes who undergo FTT for limb salvage. A multidisciplinary team approach may effectively mitigate negative outcomes in elderly, frail patients.
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