Predictors and Outcomes of Repeated Unplanned Reoperations After Free Tissue Transfer

Free tissue transfers are often completed in patients with high comorbidities, which carry significant risk for postoperative complications, including one or more reoperations. The objective of this study is to understand the prevalence and timing of these reoperations, as well as quantify demographic and clinical predictors of such outcomes.

The 2013-2022 National Surgical Quality Improvement Program database was queried for free tissue transfer operations. Records were characterized with demographic, comorbidity, preoperative, and intraoperative variables. The main outcome of interest was the occurrence of one or more unplanned reoperations. Furthermore, multivariate logistic regression was performed to identify predictors for first and second reoperation (P < 0.05).

The final patient cohort comprised 29,733 free tissue transfer patients. A total of 3671 (12.3%) patients had one unplanned reoperation, 780 (2.6%) had two unplanned reoperations, and 180 (0.6%) had more than two unplanned reoperations. Patients who experienced two reoperations had a significantly earlier occurrence of initial reoperation (4.7 ± 6.0 days) when compared to those who only experienced one reoperation (8.5 ± 9.0 days) (P < 0.001). Common predictors of both first and second reoperation were smoking history and longer operative time (P < 0.05). Notably, an initial reoperation for vascular repair (OR, 2.29; 95% CI, 1.80-2.92; P < 0.001) or additional tissue transfer (OR, 2.10; 95% CI, 1.46-3.02; P < 0.001) also conferred a higher risk for subsequent reoperation.

Prevalence of reoperations in free tissue transfer is significant. In addition to well-characterized factors like comorbidities and perioperative status, specific regions of reconstruction, and indications for initial reoperation may indicate a higher risk for subsequent reoperation, informing general postoperative risk assessment.