Factors Associated with Length of Hospital Stay in Patients Undergoing Lower Extremity Free Flap Reconstruction

Lower extremity free flap reconstruction (LE-FFR) is essential for significant soft-tissue defects, but prolonged hospital stays can negatively impact patients and health care systems. This study aimed to identify factors associated with post-flap-surgery length of stay (pfsLOS) in LE-FFR patients to optimize health care delivery and outcomes.

This retrospective cohort study included 405 patients who underwent 415 microvascular LE-FFRs at 2 level I trauma centers. The primary outcome was pfsLOS, which was then described in the context of total LOS (tLOS). Statistical analyses involved multivariable linear and Cox regression models, analyzing outcomes as relative percentage changes in pfsLOS.

Across all defect causes, median pfsLOS was 10 days (interquartile range, 8 to 14 days), with prolonged pfsLOS (>14 days) in 81 patients (20%). Combined initial plastic and orthopedic surgery treatment (primary multidisciplinary orthoplastic treatment) was associated with a significant decrease in pfsLOS (-13.58%; P = 0.047) in multivariable regression analysis, with the greatest benefit observed in high-severity cases. Other factors significantly affecting pfsLOS included the number of plastic surgery operations (14.47% increase per operation; P < 0.001), blood transfusion (13.03% increase; P = 0.023), and flap surgery duration (0.06% increase per minute; P = 0.041). The time between the first surgery and flap surgery was associated with a significant decrease in pfsLOS (-0.90% per day; P = 0.046). Subanalysis showed that discharge to destinations other than home significantly increased pfsLOS (16.45%; P = 0.001), particularly in socially deprived areas.

Initial combined orthoplastic intervention reduced pfsLOS by 9.10% to 13.58% and overall total LOS by 50.00% for LE-FFR patients. Early coordination between services reduces LOS, optimizes resource use, and likely improves cost-effectiveness and patient outcomes in LE-FFR.