Swiekatowski Kylie R, Barrera Jose E, Hopkins David, Manisundaram Arvind D, Bhadkamkar Mohin A, Wu-Fienberg Yuewei
Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, Texas.
J Reconstr Microsurg. 2025 Jun;41(5):376-382. doi: 10.1055/a-2383-6916. Epub 2024 Aug 12.
The rising clinical importance of assessing frailty is driven by its predictive capability for postoperative outcomes. This study assesses the effectiveness of RAI-rev (Revised Risk Analysis Index) in predicting adverse outcomes in lower extremity (LE) flap reconstruction.
Analyzing NSQIP (National Surgical Quality Improvement Program) data from 2015 to 2020, we compared demographics, perioperative factors, and 30-day outcomes in all locoregional and free-flap cases. Frailty scores, calculated using RAI-rev, were categorized with <15 as nonfrail and >35 as the most frail. Adjusted odds ratios (aORs) for specific complications were calculated using nonfrail as the reference group. Frailty scores in locoregional flaps were compared with those in free flaps.
We identified 270 locoregional and 107 free-flap cases. Higher RAI-rev scores in locoregional flaps correlated with increased complications, such as deep surgical site infection (1% nonfrail vs. 20% RAI 31-35), stroke (0% nonfrail vs. 17% most frail), and mortality (0% nonfrail vs. 17% most frail). Locoregional flap cases with RAI-rev scores in the most frail group had a significantly elevated aOR for stroke (51.0, 95% confidence interval [CI]: 1.8-1402.5, = 0.02), mortality (43.1, 95% CI: 1.6-1167.6, = 0.03), and any complication (6.8, 95% CI: 1.2-37.4, = 0.03). In free-flap cases, higher RAI-rev scores were associated with increased complications, with only sepsis showing a statistically significant difference (6% nonfrail vs. 100% most frail; aOR: 42.3, CI: 1.45-1245.3, = 0.03). Free-flap cases had a significantly lower RAI-rev score compared with locoregional flap cases (14.91 vs. 17.64, = 0.01).
Elevated RAI-rev scores (>35) correlated with more complications in locoregional flaps, while free-flap reconstruction patients had generally low RAI-rev scores. This suggests that free flaps are less commonly recommended for presumed higher risk patients. The study demonstrates that RAI-rev may be able to serve as a risk calculator in LE reconstruction, aiding in the assessment of candidates for limb salvage versus amputation.
评估衰弱的临床重要性日益增加，这是由其对术后结局的预测能力所驱动的。本研究评估了RAI-rev（修订风险分析指数）在预测下肢（LE）皮瓣重建不良结局方面的有效性。
分析2015年至2020年的NSQIP（国家外科质量改进计划）数据，我们比较了所有局部和游离皮瓣病例的人口统计学、围手术期因素及30天结局。使用RAI-rev计算的衰弱评分，<15分为非衰弱，>35分为最衰弱。以非衰弱组为参照组，计算特定并发症的调整优势比（aORs）。比较局部皮瓣与游离皮瓣的衰弱评分。
我们确定了270例局部皮瓣和107例游离皮瓣病例。局部皮瓣中较高的RAI-rev评分与并发症增加相关，如深部手术部位感染（非衰弱组为1%，RAI 31 - 35组为20%）、中风（非衰弱组为0%，最衰弱组为17%）和死亡率（非衰弱组为0%，最衰弱组为17%）。RAI-rev评分处于最衰弱组的局部皮瓣病例，中风的aOR显著升高（51.0，95%置信区间[CI]：1.8 - 1402.5，P = 0.02）、死亡率（43.1，95% CI：1.6 - 1167.6，P = 0.03）以及任何并发症（6.8，95% CI：1.2 - 37.4，P = 0.03）。在游离皮瓣病例中，较高的RAI-rev评分与并发症增加相关，只有败血症显示出统计学显著差异（非衰弱组为6%，最衰弱组为100%；aOR：42.3，CI：1.45 - 1245.3，P = 0.03）。游离皮瓣病例的RAI-rev评分显著低于局部皮瓣病例（14.91对17.64，P = 0.01）。
RAI-rev评分升高（>35）与局部皮瓣更多并发症相关，而游离皮瓣重建患者的RAI-rev评分通常较低。这表明对于推测风险较高的患者，游离皮瓣较少被推荐。该研究表明RAI-rev可能能够作为LE重建中的风险计算器，有助于评估保肢与截肢的候选者。
