Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Reconstr Microsurg. 2024 Feb;40(2):163-170. doi: 10.1055/a-2102-0147. Epub 2023 May 26.
Older and frailer patients are increasingly undergoing free or pedicled tissue transfer for lower extremity (LE) limb salvage. This novel study examines the impact of frailty on postoperative outcomes in LE limb salvage patients undergoing free or pedicled tissue transfer.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2010-2020) was queried for free and pedicled tissue transfer to the LE based on Current Procedural Terminology and the International Classification of Diseases9/10 codes. Demographic and clinical variables were extracted. The five-factor modified frailty index (mFI-5) was calculated using functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. Patients were stratified by mFI-5 score: no frailty (0), intermediate frailty (1), and high frailty (2 + ). Univariate analysis and multivariate logistic regression were performed.
In total, 5,196 patients underwent free or pedicled tissue transfer for LE limb salvage. A majority were intermediate ( = 1,977) or high ( = 1,466) frailty. High frailty patients had greater rates of comorbidities-including those not in the mFI-5 score. Higher frailty was associated with more systemic and all-cause complications. On multivariate analysis, the mFI-5 score remained the best predictor of all-cause complications-with high frailty associated with 1.74 increased adjusted odds when compared with no frailty (95% confidence interval: 1.47-2.05).
While flap type, age, and diagnosis were independent predictors of outcomes in LE flap reconstruction, frailty (mFI-5) was the strongest predictor on adjusted analysis. This study validates the mFI-5 score for preoperative risk assessment for flap procedures in LE limb salvage. These results highlight the likely importance of prehabilitation and medical optimization prior to limb salvage.
越来越多的老年和虚弱患者接受游离或带蒂组织转移以进行下肢（LE）肢体挽救。本研究探讨了虚弱对接受游离或带蒂组织转移的 LE 肢体挽救患者术后结局的影响。
美国外科医师学院国家外科质量改进计划（ACS-NSQIP）数据库（2010-2020 年）根据当前程序术语和国际疾病分类第 9/10 版对 LE 的游离和带蒂组织转移进行了查询。提取了人口统计学和临床变量。使用功能状态、糖尿病、慢性阻塞性肺疾病、充血性心力衰竭和高血压计算了五因素改良虚弱指数（mFI-5）。根据 mFI-5 评分对患者进行分层：无虚弱（0）、中度虚弱（1）和高度虚弱（2+）。进行了单因素分析和多因素逻辑回归分析。
共有 5196 例患者接受游离或带蒂组织转移以进行 LE 肢体挽救。大多数患者处于中度（=1977）或高度（=1466）虚弱状态。高虚弱患者的合并症发生率更高，包括不在 mFI-5 评分中的合并症。较高的虚弱程度与更多的全身和所有原因并发症相关。多因素分析显示，mFI-5 评分仍然是所有原因并发症的最佳预测指标，与无虚弱相比，高度虚弱患者的调整后优势比为 1.74（95%置信区间：1.47-2.05）。
尽管皮瓣类型、年龄和诊断是 LE 皮瓣重建结局的独立预测因素，但虚弱（mFI-5）是调整后分析中最强的预测因素。本研究验证了 mFI-5 评分在 LE 肢体挽救皮瓣手术中的术前风险评估中的有效性。这些结果突出了在肢体挽救之前进行康复和医学优化的重要性。
