Department of Plastic and Reconstructive Surgery, Head and Neck Surgery, Erie County Medical Center, Buffalo, NY, USA.
Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
Int J Oral Maxillofac Surg. 2022 Jun;51(6):746-753. doi: 10.1016/j.ijom.2021.10.009. Epub 2021 Nov 16.
The aim of this study was to evaluate the accuracy of validated preoperative patient co-morbidity assessments, including the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), with the use of the composite scapula free flap (CSFF) in maxillofacial reconstruction in patients with significant medical co-morbidities. A retrospective cohort review was performed at an academic institution, covering the period from July 2010 through January 2019. All patients who underwent reconstruction with a CSFF with significant medical co-morbidities were included. Co-morbidity assessments and risk factors were analyzed by comparing predicted versus observed early and late medical and surgical complications. Forty-five patients met the inclusion criteria. The surgical complication rate was 47%; the medical complication rate was 38%. Over 90% of patients returned to successful function at 3 months post-surgery. The ACS-NSQIP prediction of complications ranged from 58% to 75% for accuracy, 76% to 100% for sensitivity, and 50% to 69% for specificity. The prediction of a serious complication was statistically significant in patients with a Charlson Co-morbidity Index ≥7. Age ≥80 years did not significantly increase the risk of a serious complication (P = 0.23). The ACS-NSQIP failed to predict the successful use of the CSFF for patients with significant co-morbidities undergoing maxillofacial reconstruction. The selection of patients who will tolerate complex reconstruction cannot be based solely on co-morbidity charts and standardized preoperative indices.
本研究旨在评估经过验证的术前患者合并症评估的准确性，包括美国外科医师学会国家外科质量改进计划（ACS-NSQIP），并在患有严重合并症的患者中使用复合肩胛骨游离皮瓣（CSFF）进行颌面重建。在一个学术机构进行了回顾性队列研究，涵盖了 2010 年 7 月至 2019 年 1 月的时间段。所有接受 CSFF 重建且患有严重合并症的患者均被纳入研究。通过比较预测与观察到的早期和晚期医疗和手术并发症，对合并症评估和危险因素进行了分析。符合纳入标准的患者有 45 名。手术并发症发生率为 47%；医疗并发症发生率为 38%。超过 90%的患者在术后 3 个月恢复成功功能。ACS-NSQIP 对并发症的预测准确性范围为 58%至 75%，敏感性为 76%至 100%，特异性为 50%至 69%。Charlson 合并症指数≥7 的患者发生严重并发症的预测具有统计学意义（P=0.006）。年龄≥80 岁并不会显著增加严重并发症的风险（P=0.23）。ACS-NSQIP 未能预测 CSFF 在患有严重合并症的患者中成功用于颌面重建。选择能够耐受复杂重建的患者不能仅基于合并症图表和标准化术前指数。
