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Preop Vascular Interventions Tied to Adverse Outcomes in Lower-Extremity Reconstructions

Pre-reconstruction vascular interventions linked to increased odds of infection, amputation, prolonged length of stay

By Elana Gotkine HealthDay Reporter

MONDAY, May 22, 2023 (HealthDay News) — For patients with lower-extremity reconstructions, pre-reconstruction vascular interventions are associated with an increased incidence of adverse outcomes, according to a study published in the April issue of Plastic & Reconstructive Surgery-Global Open.

Scott R. Levin, M.D., from the Boston University School of Medicine, and colleagues queried the National Trauma Data Bank from 2015 to 2018 for lower-extremity reconstructions to examine patient and procedural characteristics associated with reconstruction outcomes. Data were included for 4,675 patients with lower-extremity reconstructions: local flaps, free flaps, or both (77, 19.2, and 3.8 percent, respectively).

The researchers found that in reconstructed extremities, major injuries included fractures, vascular injuries, and mangled limbs (56.2, 11.8, and 2.9 percent, respectively). Pre-reconstruction ipsilateral procedures included vascular interventions, amputations, and fasciotomies (6, 5.6, and 4.3 percent, respectively). In 2.0 and 2.6 percent of patients, postoperative surgical site infection and amputation occurred, respectively. The mean total length of stay was 23.2 ± 21.1 days among survivors; 46.8 percent were discharged to rehabilitation. Vascular interventions pre-reconstruction were associated with increased infection, amputation, prolonged length of stay, and discharge to rehab in a multivariable analysis (odds ratios, 1.99, 4.38, 1.59, and 1.49, respectively). There was an association seen between free flaps and prolonged length of stay (odds ratio, 2.08).

“Patients requiring vascular interventions may have experienced more severe trauma predisposing to complications. Patient factors, including race and diabetes, were associated with poorer outcomes and may be considered in risk-benefit analysis,” the authors write. “Future studies evaluating lower extremity reconstruction outcomes should clarify why high-risk cohorts identified in this study are at increased risk of complications and health care utilization.”

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