Reconstructive Complication Rates Following 79,846 Perineal Resections In The United States
David Chi, MD, PhD1,2, Austin D. Chen, MD1, Alexandra Bucknor, MBBS MSc MRCS (Eng)1, Patrick Bletsis, BSc1, Anmol Chattha, MD1, Sabine Egelar, MD1, Samuel J. Lin, MD, MBA1.
1Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Division of Plastic and Reconstructive Surgery, Washington University Medical Center, Saint Louis, MO, USA.
Purpose: Advanced cancers affecting the lower gastrointestinal, urological, and gynecological systems often require surgical resections to treat malignancy. These ablative defects present a great challenge to the plastic and reconstructive surgeon. This study aims to analyze national complication rates after flap reconstruction following pelvic resection.
Methods: Data were retrieved for patients undergoing pedicled flap reconstruction after perineal resections in the National Inpatient Sample (NIS) database between 2010 and 2014. Categorical variables were analyzed for differences with Pearson's Chi square test and multivariable analysis was performed utilizing logistic regression.
Results: In total, 2,366 patients underwent flap reconstruction with 1,313 men and 1,053 women receiving reconstruction. The overall complication rate was 55.3%, with 20.0% of patients most commonly developing surgical site complications. On unadjusted analysis those developing complications were more likely to have anemia (p<0.001), depression (p<0.001), electrolyte abnormalities (p=0.007) and recent weight loss (p=0.01). On multivariable analysis, anemia (OR=2.4, p<0.001) and depression (OR=2.8, p=0.004 were associated with an increased risk of developing complications. There was a decreased risk of developing complications with highest median income quartile compared with lowest (OR=0.3, p=0.001) and private insurance compared with government (OR=0.3, p=0.006). Female patients ultimately experienced more microvascular complications (9.3%) and more flap revision procedures (4.9%) compared to male patients (6.3% and 2.2%, respectively).
Conclusions: Patients undergoing flap reconstruction after perineal resections experience high complication rates. Reconstructive surgeons should approach these higher risk populations with greater awareness of socioeconomic disparities such as lower income status or government-based insurance holders having a higher complication risk.
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