Comparison of Charlson Comorbidity Index and Modified 5-factor Frailty Index as Clinical Risk Stratification Tools in Predicting Adverse Outcomes in Patients Undergoing Lower Extremity Free Flap Reconstruction.

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Citation: Journal of Reconstructive Microsurgery. 2022 Sep 20PMID: 36126961Institution: MedStar Washington Hospital CenterDepartment: MedStar General Surgery Residency | MedStar Georgetown University Hospital/MedStar Washington Hospital Center | Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2022ISSN:
  • 0743-684X
Name of journal: Journal of reconstructive microsurgeryAbstract: BACKGROUND: Free tissue transfer (FTT) reconstruction is associated with a high rate of limb salvage in patients with chronic lower extremity (LE) wounds. Studies have shown perioperative risk stratification tools (e.g., modified 5-factor frailty index (mFI-5) and Charlson Comorbidity Index (CCI)) to be useful in predicting adverse outcomes; however, no studies have compared them in patients undergoing LE reconstruction. The aim of this study is to compare the utility of mFI-5 and CCI in predicting postoperative morbidity in elderly patients receiving LE FTT reconstruction.CONCLUSION: This is the first study to compare the utility of mFI-5 and CCI in predicting adverse outcomes in elderly patients undergoing LE FTT reconstruction. Our results demonstrate CCI to be a superior predictor of secondary amputation in this patient population and mFI-5 to have limited utility. Further investigation in a prospective multicenter cohort is warranted. Copyright Thieme. All rights reserved.METHODS: A retrospective review of patients >60 years who underwent LE FTT reconstruction from 2011-2022 was performed. Comorbidity burden was measured by two validated risk-stratification tools: mFI-5 and CCI. Primary outcomes included prolonged postoperative length of stay (LOS), defined as >75th percentile of the cohort, postoperative complications, and eventual amputation.RESULTS: One-hundred fifteen patients were identified. Median CCI and mFI-5 were 5 (IQR 4,6) and 2 (IQR 1,3), respectively. Average postoperative LOS was 16.4 days. Twenty-nine patients (25.2%) experienced a postoperative complication, and eight patients (7.0%) required LE amputation at a mean follow-up of 19.8 months. Overall flap success was 96.5% (n=111), and limb salvage rate was 93% (n=108). Increased CCI was found to be independently predictive of only eventual amputation (OR 1.59, p=0.039), while mFI-5 was not predictive of prolonged postoperative LOS, flap complications, or eventual amputation.All authors: Bovill JD, Deldar R, Evans KK, Fan KL, Gupta NJ, Haffner Z, Huffman SS, Sayyed AA, Truong BNFiscal year: FY2023Digital Object Identifier: Date added to catalog: 2022-10-20
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Journal Article MedStar Authors Catalog Article 36126961 Available 36126961

BACKGROUND: Free tissue transfer (FTT) reconstruction is associated with a high rate of limb salvage in patients with chronic lower extremity (LE) wounds. Studies have shown perioperative risk stratification tools (e.g., modified 5-factor frailty index (mFI-5) and Charlson Comorbidity Index (CCI)) to be useful in predicting adverse outcomes; however, no studies have compared them in patients undergoing LE reconstruction. The aim of this study is to compare the utility of mFI-5 and CCI in predicting postoperative morbidity in elderly patients receiving LE FTT reconstruction.

CONCLUSION: This is the first study to compare the utility of mFI-5 and CCI in predicting adverse outcomes in elderly patients undergoing LE FTT reconstruction. Our results demonstrate CCI to be a superior predictor of secondary amputation in this patient population and mFI-5 to have limited utility. Further investigation in a prospective multicenter cohort is warranted. Copyright Thieme. All rights reserved.

METHODS: A retrospective review of patients >60 years who underwent LE FTT reconstruction from 2011-2022 was performed. Comorbidity burden was measured by two validated risk-stratification tools: mFI-5 and CCI. Primary outcomes included prolonged postoperative length of stay (LOS), defined as >75th percentile of the cohort, postoperative complications, and eventual amputation.

RESULTS: One-hundred fifteen patients were identified. Median CCI and mFI-5 were 5 (IQR 4,6) and 2 (IQR 1,3), respectively. Average postoperative LOS was 16.4 days. Twenty-nine patients (25.2%) experienced a postoperative complication, and eight patients (7.0%) required LE amputation at a mean follow-up of 19.8 months. Overall flap success was 96.5% (n=111), and limb salvage rate was 93% (n=108). Increased CCI was found to be independently predictive of only eventual amputation (OR 1.59, p=0.039), while mFI-5 was not predictive of prolonged postoperative LOS, flap complications, or eventual amputation.

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