Jain Nirbhay S, Bingham Elijah, Luvisa B Kyle, Frydrych Lynn M, Chin Madeline G, Bedar Meiwand, Da Lio Andrew, Roostaeian Jason, Crisera Christopher, Slack Ginger, Tseng Charles, Festekjian Jaco H, Delong Michael R
From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Plast Reconstr Surg Glob Open. 2023 Jul 18;11(7):e5125. doi: 10.1097/GOX.0000000000005125. eCollection 2023 Jul.
Breast reconstruction remains a major component of the plastic surgeon's repertoire, especially free-flap breast reconstruction (FFBR), though this is a high-risk surgery in which patient selection is paramount. Preoperative predictors of complication remain mixed in their utility. We sought to determine whether the sarcopenia score, a validated measure of physiologic health, outperforms the body mass index (BMI) and modified frailty index (mFI) in terms of predicting outcomes.
All patients with at least 6-months follow-up and imaging of the abdomen who underwent FFBR from 2013 to 2022 were included in this study. Appropriate preoperative and postoperative data were included, and sarcopenia scores were extracted from imaging. Complications were defined as any unexpected outcome that required a return to the operating room or readmission. Statistical analysis and regression were performed.
In total, 299 patients were included. Patients were split into groups, based on sarcopenia scores. Patients with lower sarcopenia had significantly more complications than those with higher scores. BMI and mFI both did not correlate with complication rates. Sarcopenia was the only independent predictor of complication severity when other factors were controlled for in a multivariate regression model.
Sarcopenia correlates with the presence of severe complications in patients who undergo FFBR in a stronger fashion to BMI and the mFI. Thus, sarcopenia should be considered in the preoperative evaluation in patients undergoing FFBR.
乳房重建仍然是整形外科医生业务范围的一个主要组成部分，尤其是游离皮瓣乳房重建（FFBR），尽管这是一项高风险手术，其中患者选择至关重要。并发症的术前预测指标在效用方面仍然参差不齐。我们试图确定肌肉减少症评分（一种经过验证的生理健康指标）在预测结果方面是否优于体重指数（BMI）和改良衰弱指数（mFI）。
本研究纳入了2013年至2022年期间接受FFBR且至少随访6个月并进行腹部成像的所有患者。纳入了适当的术前和术后数据，并从成像中提取肌肉减少症评分。并发症定义为任何需要返回手术室或再次入院的意外结果。进行了统计分析和回归分析。
总共纳入了299名患者。根据肌肉减少症评分将患者分为几组。肌肉减少症评分较低的患者并发症明显多于评分较高的患者。BMI和mFI均与并发症发生率无关。在多变量回归模型中控制其他因素时，肌肉减少症是并发症严重程度的唯一独立预测因素。
在接受FFBR的患者中，肌肉减少症与严重并发症的存在之间的关联比BMI和mFI更强。因此，在接受FFBR的患者的术前评估中应考虑肌肉减少症。
