Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Plast Surg Hand Surg. 2020 Apr;54(2):67-76. doi: 10.1080/2000656X.2019.1688166. Epub 2019 Nov 18.
The elderly population in the United States is expanding rapidly, and with advancements in modern medicine, the number of elderly patients undergoing surgery has risen in parallel. The aim of this study was to evaluate the effect of age and frailty on postoperative outcomes following pedicled flap reconstruction. The 2005-2016 ACS-NSQIP databases were queried to identify cases involving pedicled flaps based on CPT codes. Demographic data and postoperative complications were assessed using Chi-square and -tests for analysis of categorical and continuous variables, respectively. A multivariable regression analysis was conducted to control for confounders. A total of 44,986 cases were included in our analysis. Patients in the 70-79year age group had the highest rates of all-cause (31.2%), mild systemic (25.3%) and severe systemic (7.4%) complications. Multivariable regression identified age as an independent risk factor for all-cause, severe systemic and wound complications. A score of 3+ on the 5-factor modified frailty index (mFI-5) was associated with all-cause, severe systemic and wound complications. When stratified by flap location, age was predictive of all-cause complications for breast, trunk, upper extremity and lower extremity flaps. Finally, mFI-5 score of 3+ was identified as an independent risk factor for all-cause complications in flaps of the head and neck, trunk and lower extremity. Although, increased age does contribute to risk of postoperative complications, the frailty index appears to hold much stronger predictive capacity. These findings stress the importance of optimizing preoperative comorbidities to reduce the risk of poor postoperative outcomes.
美国的老年人口正在迅速增加，随着现代医学的进步，接受手术的老年患者数量也在增加。本研究旨在评估年龄和虚弱对带蒂皮瓣重建术后结果的影响。我们查询了 2005 年至 2016 年 ACS-NSQIP 数据库，根据 CPT 代码确定了涉及带蒂皮瓣的病例。使用卡方检验和 t 检验分别评估了分类和连续变量的人口统计学数据和术后并发症。进行多变量回归分析以控制混杂因素。我们的分析共纳入了 44986 例病例。70-79 岁年龄组的患者的所有原因（31.2%）、轻度全身（25.3%）和严重全身（7.4%）并发症发生率最高。多变量回归分析确定年龄是所有原因、严重全身和伤口并发症的独立危险因素。5 因素改良虚弱指数（mFI-5）评分为 3+与所有原因、严重全身和伤口并发症相关。按皮瓣位置分层时，年龄是乳房、躯干、上肢和下肢皮瓣所有原因并发症的预测因素。最后，mFI-5 评分 3+被确定为头颈部、躯干和下肢皮瓣所有原因并发症的独立危险因素。尽管年龄的增加确实会增加术后并发症的风险，但虚弱指数似乎具有更强的预测能力。这些发现强调了优化术前合并症以降低不良术后结果风险的重要性。
