Subscribe to RSS
Analysis of Readmissions and Reoperations in Pediatric Microvascular ReconstructionFunding None.
Background Free tissue transfer is utilized as a reconstructive option for various anatomic defects. While it has long been performed in adults, reconstructive surgeons have used free tissue transfer to a lesser degree in children. As such, there are few analyses of factors associated with complications in free tissue transfer within this population. The aim of this study is to assess factors associated with readmission and reoperation in pediatric free flap patients utilizing the pediatric National Surgical Quality Improvement Program database.
Methods Pediatric patients who underwent microvascular reconstruction between 2015 and 2020 were included. Patients were identified by five microvascular reconstruction Current Procedural Terminology codes and were then stratified by flap site (head and neck, extremities, trunk) and defect etiology (congenital, trauma, infection, neoplasm). Multivariate logistic regression was performed to identify factors associated with readmissions and reoperations.
Results The study cohort consisted of 258 patients. The average age was 10.0 ± 4.7 years and the majority of patients were male (n = 149, 57.8%), were of white race (n = 164, 63.6%), and had a normal body mass index. Twenty-two patients (8.5%) experienced an unplanned readmission within 30 days of the initial operation, most commonly for wound disruption (31.8% of readmissions). The overall rate of unplanned reoperation within 30 days was 11.6% (n = 30) for all patients, with an average of 8.9 ± 7.5 days to reoperation. On multivariate regression analysis, each hour increase in operative time was associated with an increased odds of reoperation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.12, 1.45) and readmission (OR: 1.16; 95% CI: 1.02, 1.34).
Conclusion In pediatric patients undergoing free tissue transfer, higher readmission and reoperation risk was associated with longer operative duration. Overall, free tissue transfer is safe in the pediatric population with relatively low rates of readmission and reoperation.
Keywordspediatric - free flap - complications - microvascular - readmission - reoperation - microsurgery
All authors above appropriately contributed to the development of this manuscript. The conceptualization of the goals/aims of the article was driven by A.C.K., J.A., G.P., and W.M. The formal acquisition and analysis of the data were performed by D.E. and B.B., G.P., W.M., S.M., T.W., J.A., and A.C.K. were involved in drafting and revising the final version for submission.
Received: 20 December 2021
Accepted: 29 May 2022
Article published online:
11 August 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Lee ZH, Daar DA, Stranix JT. et al. Risk factors for microvascular free flaps in pediatric lower extremity trauma. Microsurgery 2020; 40 (01) 44-50
- 2 Alkureishi LWT, Purnell CA, Park P, Bauer BS, Fine NA, Sisco M. Long-term outcomes after pediatric free flap reconstruction. Ann Plast Surg 2018; 81 (04) 449-455
- 3 Momeni A, Lanni M, Levin LS, Kovach SJ. Microsurgical reconstruction of traumatic lower extremity defects in the pediatric population. Plast Reconstr Surg 2017; 139 (04) 998-1004
- 4 Upton J, Guo L. Pediatric free tissue transfer: a 29-year experience with 433 transfers. Plast Reconstr Surg 2008; 121 (05) 1725-1737
- 5 ACS NSQIP Pediatric Participant Use Data File. American College of Surgeons. Accessed July 9, 2022, Accessed October 20, 2021. http://www.facs.org/quality-programs/childrens-surgery/pediatric/program-specifics/quality-support-tools/puf
- 6 Parikh RP, Ha A, Tung T. Free flap reconstruction of traumatic pediatric foot and ankle defects: an analysis of clinical and functional outcomes. J Reconstr Microsurg 2021; 37 (09) 783-790
- 7 Elbatawy A, Elgammal M, Zayid T. et al. Pediatric microsurgery in the reconstruction of complex posttraumatic foot and ankle defects: a long-term follow-up with a comprehensive review of the literature. J Reconstr Microsurg 2021; 37 (03) 193-200
- 8 Colman M, Wright A, Gruen G, Siska P, Pape HC, Tarkin I. Prolonged operative time increases infection rate in tibial plateau fractures. Injury 2013; 44 (02) 249-252
- 9 Fogarty BJ, Khan K, Ashall G, Leonard AG. Complications of long operations: a prospective study of morbidity associated with prolonged operative time (> 6 h). Br J Plast Surg 1999; 52 (01) 33-36
- 10 Hardy KL, Davis KE, Constantine RS. et al. The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases. Aesthet Surg J 2014; 34 (04) 614-622
- 11 Offodile II AC, Aherrera A, Wenger J, Rajab TK, Guo L. Impact of increasing operative time on the incidence of early failure and complications following free tissue transfer? A risk factor analysis of 2,008 patients from the ACS-NSQIP database. Microsurgery 2017; 37 (01) 12-20
- 12 Andrew TW, Baylan J, Mittermiller PA. et al. Virtual surgical planning decreases operative time for isolated single suture and multi-suture craniosynostosis repair. Plast Reconstr Surg Glob Open 2018; 6 (12) e2038 DOI: 10.1097/GOX.0000000000002038.
- 13 Chang EI, Jenkins MP, Patel SA, Topham NS. Long-term operative outcomes of preoperative computed tomography-guided virtual surgical planning for osteocutaneous free flap mandible reconstruction. Plast Reconstr Surg 2016; 137 (02) 619-623
- 14 Spanio S, Ashammakhi N, Ilomäki J. et al. Use of new bioabsorbable tacks and a tackshooter in cranial bone osteofixation saves operative time. J Craniofac Surg 2002; 13 (05) 693-696 , discussion 697
- 15 Tapking C, Kowalewski KF, Hundeshagen G, Kneser U, Hirche C. A systematic review of learning curves in plastic and reconstructive surgery procedures. Ann Plast Surg 2020; 85 (03) 324-331
- 16 Allen RW, Pruitt M, Taaffe KM. Effect of resident involvement on operative time and operating room staffing costs. J Surg Educ 2016; 73 (06) 979-985
- 17 Peterson EC, Ghosh TD, Qureshi AA, Myckatyn TM, Tenenbaum MM. Impact of Residents on Operative Time in Aesthetic Surgery at an Academic Institution. Aesthet Surg J Open Forum 2019 Oct 7; 1(4):ojz026. Doi: 10.1093/asjof/ojz026. PMID: 33791617; PMCID: PMC7671284.
- 18 Xu R, Carty MJ, Orgill DP, Lipsitz SR, Duclos A. The teaming curve: a longitudinal study of the influence of surgical team familiarity on operative time. Ann Surg 2013; 258 (06) 953-957
- 19 Alluri RK, Leland H, Heckmann N. Surgical research using national databases. Ann Transl Med 2016; 4 (20) 393 DOI: 10.21037/atm.2016.10.49.
- 20 Sippel RS, Chen H. Limitations of the ACS NSQIP in thyroid surgery. Ann Surg Oncol 2011; 18 (13) 3529-3530
- 21 Epelboym I, Gawlas I, Lee JA, Schrope B, Chabot JA, Allendorf JD. Limitations of ACS-NSQIP in reporting complications for patients undergoing pancreatectomy: underscoring the need for a pancreas-specific module. World J Surg 2014; 38 (06) 1461-1467