TY  - BOOK
AU  - Deldar, Romina 
AU  - Fan, Kenneth
TI  - 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
SN  - 0743-684X
PY  - 2022///
KW  - IN PROCESS -- NOT YET INDEXED
KW  - MedStar Washington Hospital Center
KW  - MedStar General Surgery Residency
KW  - MedStar Georgetown University Hospital/MedStar Washington Hospital Center
KW  - Surgery/Plastic Surgery
KW  - Journal Article
N2  - 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
UR  - https://dx.doi.org/10.1055/a-1947-8299
ER  -