Disparities in Delays to Lower Extremity Free Flap Reconstructions

Lower extremity flap reconstructions are often due to traumatic injuries requiring emergency surgeries. Studies found that delays to operating increase morbidity, mortality, and length of hospital stay. There are limited studies assessing disparities in delays to reconstruction. This study investigates factories correlated to delays in surgery in lower extremity reconstructions.

In a single center from January 2015 to January 2024, 80 patients who underwent a lower extremity flap reconstruction and remained inpatient until their reconstruction operation were identified. The time to surgery from admission, time to consult, and time from consult to surgery were collected. Delays to flap were defined as >14 days from admission to surgery. Demographics, substance use history, Charlson Comorbidity Index, and Trauma Severity Score were collected. A multiple analysis of variance for quantitative variables and a χ2 test for categorical variables were conducted. Variables with significant values on univariate analysis were further analyzed using a multivariate logistic regression to account for confounding variables.

In the delay to flap (DF) cohort (n = 40) and no delay to flap (ND) cohort (n = 40), minority patients were more likely to experience delays to flap (P < 0.001). Surprisingly, there were no correlations to Charlson Comorbidity Index, Trauma Severity Score, marijuana, or illegal drug use. ND patients were more likely to have a history of tobacco use (P = 0.012). DF patients correlated with a significantly longer time to consult (DF: 8.1 d, ND: 2.3 d, P < 0.001) and time to surgery from consult (18.3 d, 5.8 d, P < 0.001). There was a significant correlation between DF and preoperative infection (P = 0.012). DF patients were significantly associated with hypertension (P = 0.030) and less likely to have gastroesophageal reflux disease (P = 0.032). Of significant factors, hypertension was significantly associated with complications (P = 0.037).

Patients who experience delays to flap were more likely to be a minority, have preoperative infections, delayed time to consult, and hypertension. Although postoperative infection was correlated with ND, DF patients were associated with preoperative infections. This suggests that there may be a disparity of infection management, susceptibility to infection, and flap recognition that lead to delays to lower extremity reconstruction. Larger prospective studies may be helpful to further evaluate reasons for delays.