From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health.
Plast Reconstr Surg. 2020 Dec;146(6):790e-795e. doi: 10.1097/PRS.0000000000007363.
Congestive heart failure affects 6.2 million people in the United States. Patients have a decreased cardiopulmonary reserve and often suffer from peripheral edema, important considerations in lower extremity reconstructive surgery. In this study, the authors sought to determine the impact of congestive heart failure on postoperative outcomes following lower extremity pedicled flap reconstruction using a national multi-institutional database.
The authors isolated all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent lower extremity pedicled flap reconstruction from 2010 to 2016. Preoperative, intraoperative, and postoperative variables were compared between patients with and without congestive heart failure. Multivariable regressions were performed to determine the independent effect of congestive heart failure on postoperative outcomes.
The authors identified 1895 patients who underwent lower extremity pedicled flap reconstruction, of whom 34 suffered from congestive heart failure. No significant difference was observed between patients with versus without congestive heart failure in postoperative wound complications (superficial wound infection, deep wound infection, and wound dehiscence), renal failure, or readmission. On multivariable analysis, congestive heart failure was independently associated with increased cardiopulmonary complications (i.e., myocardial infarction, cardiac arrest, pneumonia, reintubation, and failed ventilator weaning) (OR, 3.92; 95 percent CI, 1.53 to 9.12), septic events (OR, 4.65; 95 percent CI, 2.05 to 10.02), and length of hospital stay (β, 0.37; 95 percent CI, 0.01 to 0.72).
In patients undergoing lower extremity pedicled flap reconstruction, congestive heart failure independently predicts a four-fold increase in postoperative sepsis and cardiopulmonary complications and a significantly increased length of hospital stay. The authors' findings highlight the need for heightened perioperative vigilance and medical optimization in this high-risk population.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
充血性心力衰竭影响美国 620 万人。患者心肺储备能力下降，常伴有外周水肿，这是下肢重建手术的重要考虑因素。在这项研究中，作者试图利用国家多机构数据库确定充血性心力衰竭对下肢带蒂皮瓣重建术后结果的影响。
作者从美国外科医师学会国家手术质量改进计划数据库中筛选出 2010 年至 2016 年间接受下肢带蒂皮瓣重建的所有患者。比较充血性心力衰竭患者与非充血性心力衰竭患者的术前、术中及术后变量。进行多变量回归分析，以确定充血性心力衰竭对术后结果的独立影响。
作者共纳入 1895 例行下肢带蒂皮瓣重建的患者，其中 34 例患有充血性心力衰竭。充血性心力衰竭患者与非充血性心力衰竭患者在术后伤口并发症（浅表伤口感染、深部伤口感染和伤口裂开）、肾衰竭或再入院方面无显著差异。多变量分析显示，充血性心力衰竭与心肺并发症（心肌梗死、心脏骤停、肺炎、再插管和呼吸机脱机失败）（比值比，3.92；95%置信区间，1.53 至 9.12）、感染性事件（比值比，4.65；95%置信区间，2.05 至 10.02）和住院时间延长（β，0.37；95%置信区间，0.01 至 0.72）独立相关。
在行下肢带蒂皮瓣重建的患者中，充血性心力衰竭独立预测术后脓毒症和心肺并发症增加 4 倍，住院时间显著延长。作者的研究结果强调了在这一高危人群中需要加强围手术期监测和医疗优化。
临床问题/证据水平：风险，II。
