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Analysis of risk factors associated with microvascular free flap failure using a multi-institutional database
Alex K Wong1, T Joanna Nguyen, Mirna Peric
1Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA.
Background:
There are numerous factors that may contribute to microvascular free flap failure. Although technical issues are dominant factors, patient and clinical characteristics are also contributory. The aim of this study was to investigate non-technical variables associated with microsurgical free flap failure using a multi-institutional dataset.
Methods:
Utilizing the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database, we identified all patients who underwent microvascular free tissue transfer from 2005 through 2009. Univariate analysis was performed to determine the association of flap failure with the following factors: age, gender, ethnicity, body mass index, intraoperative transfusion, diabetes, smoking, alcohol, American Society of Anesthesiologists classification, year of operation, operative time, number of flaps, and type of reconstruction. Factors with a significance of P < 0.2 in the univariate analysis were included in the multivariate logistic regression model to identify independent risk factors.
Results:
A total of 639 patients underwent microsurgical free flap reconstruction with 778 flaps over the 4-year study period; 139 patients had two free flaps during the same operation. The overall incidence of flap failure was 4.4% (34/778) (95% confidence interval [CI]: 3.0%, 6.2%). Operative time was identified as an independent risk factor for free flap failure. After adjusting for other factors, those whose operative time was equal to or greater than the 75th percentile (625.5 min) were twice as likely to experience flap failure (AOR 2.09; 95% CI: 1.01-4.31; P = 0.045). None of the other risk factors studied were significant contributors.
Conclusions:
In this series, the overall flap loss rate of was 4.4%. Operative time was a significant independent risk factor for flap failure.
Insights
Prolonged operative time significantly increases the risk of microvascular free flap failure. Surgeons should consider operative duration as a critical factor in free flap reconstruction outcomes.
Area of Science:
- Microsurgery
- Plastic Surgery
- Surgical Outcomes
Background:
- Microvascular free flap failure can result from various factors, including technical issues and patient characteristics.
- Non-technical variables are increasingly recognized as significant contributors to flap success.
Purpose of the Study:
- To investigate non-technical variables associated with microsurgical free flap failure.
- Utilizing a multi-institutional dataset to identify risk factors for flap loss.
Main Methods:
- Analysis of the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database (2005-2009).
- Inclusion of patients undergoing microvascular free tissue transfer.
- Multivariate logistic regression to identify independent risk factors for flap failure.
Main Results:
- Overall flap failure rate was 4.4% (34/778 flaps).
- Operative time exceeding the 75th percentile (625.5 min) was independently associated with a twofold increase in flap failure risk (AOR 2.09).
- No other studied non-technical factors were significant contributors to flap failure.
Conclusions:
- The flap loss rate in this study was 4.4%.
- Operative time is a significant independent risk factor for microvascular free flap failure.
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