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MICRO: Microsurgical Index for Complication Risk and Outcomes
Thomas M Johnstone1,2, Daniel Najafali1,3, Priscila C Cevallos1,4
1Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, California.
Journal of Reconstructive Microsurgery
|April 7, 2025
Summary
A new tool, the Microsurgical Index for Complication Risk and Outcomes (MICRO), predicts complications after free tissue transfer (FTT). This index offers a simpler, more accurate way to assess patient risk compared to existing methods.
Area of Science:
- Plastic Surgery
- Microsurgery
- Health Informatics
Background:
- Free tissue transfer (FTT) outcomes are influenced by numerous patient and surgeon factors.
- Currently, no validated tool exists to quantify patient-specific risks for complications following FTT procedures.
- Existing comorbidity indexes lack specificity for predicting FTT complications.
Purpose of the Study:
- To develop and validate a novel risk assessment tool, the Microsurgical Index for Complication Risk and Outcomes (MICRO), for predicting postoperative complications after FTT.
- To compare the predictive performance of the MICRO against established comorbidity indexes.
Main Methods:
- Retrospective analysis of 5,595 patients undergoing FTT with microsurgical anastomosis from the 2007-2015 MarketScan Databases.
- Development of the MICRO using forward stepwise selection from Elixhauser comorbidities, incorporating expert input.
- Multivariate logistic regression models utilizing patient demographics, comorbidities, and flap type to predict 90-day postoperative complications.
- Evaluation of predictive performance using Area Under the Receiver Operating Characteristic Curve (AUROCC) and cross-validation accuracy.
Main Results:
- The final MICRO comprises seven variables, outperforming existing comorbidity indexes.
- The MICRO achieved an AUROCC of 0.60 and a classification accuracy of 60.4% in predicting complications.
- The developed index demonstrated superior predictive capability with a reduced number of variables compared to Charlson and Elixhauser indexes.
Conclusions:
- The MICRO is a validated, concise tool that effectively predicts complications following free tissue transfer.
- It offers a significant improvement over existing comorbidity indexes for risk stratification in FTT patients.
- Future research should aim to enhance the MICRO by integrating surgeon and site-specific data for more precise risk assessment.
