Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study
<p>Kaplan–Meier survival analysis for LDM and GM cohort.</p> "> Figure 2
<p>Analysis of microcirculation in viable GM flaps (Alive <span class="html-italic">n</span> = 26; Dead <span class="html-italic">n</span> = 9). Data are depicted for flow, SO<sub>2</sub>, and rHb over the 72 h time period investigated.</p> "> Figure 3
<p>Analysis of microcirculation in viable LDM flaps (Alive <span class="html-italic">n</span> = 28; Dead <span class="html-italic">n</span> = 4). Data are depicted for flow, SO<sub>2</sub>, and rHb over the 72 h time period investigated.</p> ">
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patients
2.3. Data Collection and Outcome Parameters
2.4. Statistical Analysis
3. Results
3.1. Factors Affecting Patient Survival
3.2. Analysis of Microcirculation
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Co-Morbidities |
---|
Cardiological diseases: arterial hypertension/CAD/arrhythmia/cardiomyopathy |
Vascular diseases: PAD/thrombosis |
Metabolic diseases: diabetes/osteoporosis/thyroid disease/hyperuricemia |
Tumors |
Internal diseases: CKI/chronic hematological diseases/COPD/rheumatoid diseases/liver failure |
Addiction to substances: nicotine/alcohol/opiate |
Neurological diseases: polyneuropathy/ataxia/epilepsies |
Musculoskeletal diseases: endoprosthesis/facture |
Infectious diseases: hepatitis B |
Medication |
---|
Anticoagulant/Antiplatelet: aggregation inhibitors/NOAC/vitamin K antagonists/heparine |
Antihypertensives: beta-blockers/RAAS/ Ca2+ antagonists/others |
Diuretics |
Statins |
Antidiabetics |
Antibiotics/antifungals |
Medication for metabolic diseases: L-thyroxin/irenat/allopurinol/colecalciferol |
Immunomodulators: cemiplimab/cortisone |
Painkillers: (a) NSAID; (b) low-potency opioids; (c) high-potency opioids |
Anticonvulsant drugs |
Antidepressants |
Gastrointestinal-related drugs: pantoprazole/laktulose/pankreatin |
Variable | Alive | Dead | p-Value | ||
---|---|---|---|---|---|
Age (Y) | 58.29 | SD 17.91 | 71.39 | 11.13 | <0.001 |
Gender | |||||
male | 67 | 56.80% | 18 | 54.50% | |
female | 51 | 43.20% | 15 | 45.50% | 0.819 |
Type of flap | |||||
LDM | 53 | 44.90% | 14 | 42.40% | |
GM | 65 | 55.10% | 19 | 57.60% | 0.799 |
Time of Surgery (min) | 327.14 | SD 99.25 | 332.48 | 95.17 | 0.803 |
Flap Ischemia (min) | 48.47 | SD 16.13 | 49.69 | 15.04 | 0.534 |
Hospitalization (d) | 29.66 | SD 26.97 | 36.88 | 31.26 | 0.046 |
Revision | |||||
no | 105 | 89.00% | 27 | 81.80% | |
yes | 13 | 11.00% | 6 | 18.20% | 0.371 |
Flap loss | |||||
no | 114 | 96.60% | 29 | 87.90% | |
yes | 4 | 3.39% | 4 | 12.12% | 0.069 |
Defect etiology | |||||
Tumor | 49 | 41.50% | 14 | 42.40% | |
Trauma | 38 | 32.20% | 7 | 21.20% | |
Chronic Wound | 31 | 26.30% | 12 | 36.40% | 0.373 |
Defect location | |||||
Head and Neck | 30 | 25.40% | 9 | 27.30% | |
Trunk | 8 | 6.80% | 3 | 9.10% | |
Upper extremity | 18 | 15.30% | 2 | 6.10% | |
Lower extremity | 62 | 52.50% | 19 | 57.60% | 0.574 |
Variable | Alive | Dead | p-Value | ||
---|---|---|---|---|---|
Cardiovascular | |||||
no | 75 | 63.60% | 11 | 33.30% | |
yes | 43 | 36.40% | 22 | 66.70% | 0.002 |
Vasculopathy | |||||
no | 89 | 75.40% | 24 | 72.70% | |
yes | 29 | 24.60% | 9 | 27.30% | 0.752 |
Metabolic Disease | |||||
no | 78 | 66.10% | 15 | 45.50% | |
yes | 40 | 33.90% | 18 | 54.50% | 0.031 |
Tumor | |||||
no | 84 | 71.20% | 18 | 54.50% | |
yes | 34 | 28.80% | 15 | 45.50% | 0.071 |
other internal medicine disease | |||||
no | 74 | 62.70% | 16 | 38.50% | |
yes | 44 | 37.30% | 17 | 51.50% | 0.141 |
Neurologic | |||||
no | 92 | 78.00% | 28 | 84.80% | |
yes | 26 | 22.00% | 5 | 15.20% | 0.387 |
Musculoskeletal | |||||
no | 85 | 72.00% | 26 | 78.80% | |
yes | 33 | 28.00% | 7 | 21.20% | 0.437 |
Infectious | |||||
no | 108 | 91.50% | 31 | 93.90% | |
yes | 10 | 8.50% | 2 | 6.10% | 1 |
Addictives | |||||
no | 93 | 78.80% | 26 | 78.80% | |
yes | 25 | 21.20% | 7 | 21.20% | 0.997 |
ASA Score | |||||
1 | 3 | 2.50% | 0 | 0.00% | |
2 | 42 | 35.60% | 2 | 6.10% | |
3 | 69 | 58.50% | 28 | 84.80% | |
4 | 4 | 3.40% | 3 | 9.10% | 0.004 |
Variable | Alive | Dead | p-Value | ||
---|---|---|---|---|---|
Anticoagulant/Antiplatelet | |||||
no | 49 | 41.50% | 6 | 18.20% | |
yes | 69 | 58.50% | 27 | 81.80% | 0.014 |
Antihypertensive | |||||
no | 71 | 60.20% | 15 | 45.50% | |
yes | 47 | 39.80% | 18 | 54.50% | 0.131 |
Diuretics | |||||
no | 89 | 75.40% | 20 | 60.60% | |
yes | 29 | 24.60% | 13 | 39.40% | 0.093 |
Statins | |||||
no | 92 | 78.00% | 23 | 69.70% | |
yes | 26 | 22.00% | 10 | 30.30% | 0.324 |
Antidiabetics | |||||
no | 103 | 87.30% | 23 | 69.70% | |
yes | 15 | 12.70% | 10 | 30.30% | 0.016 |
Antibiotics/Antimycotics | |||||
no | 72 | 61.00% | 16 | 48.50% | |
yes | 46 | 39.00% | 17 | 51.50% | 0.197 |
Metabolism | |||||
no | 80 | 67.80% | 12 | 36.40% | |
yes | 38 | 32.20% | 21 | 63.60% | 0.001 |
Immunomodulators | |||||
no | 107 | 90.70% | 29 | 87.90% | |
yes | 11 | 9.30% | 4 | 12.10% | 0.742 |
NSAID | |||||
no | 60 | 50.80% | 19 | 57.60% | |
yes | 58 | 49.20% | 14 | 42.40% | 0.494 |
Low-potency opioid | |||||
no | 99 | 83.90% | 30 | 90.90% | |
yes | 19 | 16.10% | 3 | 9.10% | 0.410 |
High-potency opioid | |||||
no | 106 | 89.80% | 29 | 87.90% | |
yes | 12 | 10.20% | 4 | 12.10% | 0.752 |
Anticonvulsant | |||||
no | 96 | 81.40% | 30 | 90.90% | |
yes | 22 | 18.60% | 3 | 9.10% | 0.192 |
Antidepressant | |||||
no | 104 | 88.10% | 27 | 81.80% | |
yes | 14 | 11.90% | 6 | 18.20% | 0.385 |
Time (h) | Flow | SD | p-Value | SO2 | SD | p-Value | rHb | SD | p-Value | |
---|---|---|---|---|---|---|---|---|---|---|
3 | Alive | 103.73 | 38.67 | 63.81 | 14.84 | 52.5 | 12.57 | |||
Dead | 118 | 56.30 | 0.45 | 46.43 | 11.73 | 0.01 | 68.43 | 18.25 | 0.01 | |
6 | Alive | 110.45 | 40.14 | 53.43 | 18.48 | 50.67 | 13.341 | |||
Dead | 115.43 | 45.91 | 0.79 | 36.43 | 25.30 | 0.07 | 55.14 | 16.96 | 0.48 | |
12 | Alive | 117.08 | 39.25 | 60.29 | 13.21 | 50.17 | 12.98 | |||
Dead | 124 | 493.5 | 0.72 | 46.67 | 19.50 | 0.05 | 53.83 | 21.61 | 0.60 | |
18 | Alive | 131.96 | 40.26 | 65.87 | 14.03 | 49.04 | 13.46 | |||
Dead | 142.17 | 49.01 | 0.6 | 53.67 | 13.78 | 0.01 | 51.17 | 16.46 | 0.74 | |
24 | Alive | 134.15 | 37.68 | 64.65 | 19.14 | 49.4 | 13.10 | |||
Dead | 131.25 | 47.01 | 0.86 | 55.75 | 13.80 | 0.24 | 52.75 | 12.37 | 0.54 | |
36 | Alive | 141.95 | 34.62 | 65.36 | 13.57 | 49.63 | 11.76 | |||
Dead | 138 | 43.93 | 0.78 | 53.5 | 15.85 | 0.05 | 52.62 | 10.66 | 0.53 | |
48 | Alive | 131.94 | 23.82 | 62.44 | 12.01 | 47.28 | 12.87 | |||
Dead | 155 | 47.15 | 0.14 | 55.8 | 16.39 | 0.32 | 51.2 | 11.73 | 0.55 | |
60 | Alive | 126.31 | 32.51 | 62.19 | 11.61 | 46.69 | 13.25 | |||
Dead | 162.75 | 48.67 | 0.08 | 51 | 9.59 | 0.09 | 47.5 | 7.50 | 0.90 | |
72 | Alive | 130.14 | 25.78 | 65 | 17.04 | 47 | 16.06 | |||
Dead | 151.75 | 56.35 | 0.40 | 49.75 | 15.90 | 0.18 | 57.25 | 9.14 | 0.28 |
Time (h) | Flow | SD | p-Value | SO2 | SD | p-Value | rHb | SD | p-Value | |
---|---|---|---|---|---|---|---|---|---|---|
3 | Alive | 91.55 | 37.05 | 38 | 24.94 | 36.1 | 10.73 | |||
Dead | 78.83 | 21.13 | 0.56 | 18.67 | 18.58 | 0.21 | 28.33 | 1.53 | 0.23 | |
6 | Alive | 110 | 42.51 | 37.92 | 18,.42 | 35.5 | 9.62 | |||
Dead | 120.75 | 53.74 | 0.65 | 28.5 | 14.15 | 0.34 | 34.5 | 10.15 | 0.85 | |
12 | Alive | 122.69 | 54.92 | 37.73 | 20.65 | 31.92 | 10.84 | |||
Dead | 114.25 | 44.57 | 0.77 | 25.75 | 12.12 | 0.27 | 36.75 | 13.30 | 0.43 | |
18 | Alive | 125.88 | 52.90 | 35.27 | 21.40 | 32.77 | 8.39 | |||
Dead | 123 | 40.68 | 0.92 | 22.25 | 10.90 | 0.25 | 32.5 | 10.78 | 0.95 | |
24 | Alive | 123.8 | 42.02 | 36.52 | 20.49 | 34.32 | 7.12 | |||
Dead | 103.75 | 28.42 | 0.37 | 20.5 | 10.78 | 0.14 | 37 | 17.18 | 0.58 | |
36 | Alive | 126.30 | 36.14 | 41.91 | 20.12 | 34.39 | 7.94 | |||
Dead | 124 | 22.04 | 0.90 | 30.75 | 9.29 | 0.29 | 41.75 | 7.63 | 0.1 | |
48 | Alive | 119.75 | 25.14 | 36.58 | 19.47 | 35.92 | 12.11 | |||
Dead | 128 | 35.51 | 0.61 | 19.33 | 13.50 | 0.15 | 38 | 8.54 | 0.78 | |
60 | Alive | 121.52 | 39.28 | 37.7 | 18.83 | 35.96 | 10.78 | |||
Dead | 141.33 | 69.02 | 0.46 | 28.67 | 8.62 | 0.43 | 40.33 | 11.68 | 0.52 | |
72 | Alive | 123.63 | 57.15 | 31.79 | 17.02 | 34.74 | 8.39 | |||
Dead | 103 | 1.41 | 0.62 | 30 | 1.41 | 0.89 | 41.5 | 10.61 | 0.30 |
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Moellhoff, N.; Taha, S.; Wachtel, N.; Hirschmann, M.; Hellweg, M.; Giunta, R.E.; Ehrl, D. Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study. Diagnostics 2022, 12, 2877. https://doi.org/10.3390/diagnostics12112877
Moellhoff N, Taha S, Wachtel N, Hirschmann M, Hellweg M, Giunta RE, Ehrl D. Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study. Diagnostics. 2022; 12(11):2877. https://doi.org/10.3390/diagnostics12112877
Chicago/Turabian StyleMoellhoff, Nicholas, Sara Taha, Nikolaus Wachtel, Maximilian Hirschmann, Marc Hellweg, Riccardo E. Giunta, and Denis Ehrl. 2022. "Analysis of Factors Determining Patient Survival after Receiving Free-Flap Reconstruction at a Single Center—A Retrospective Cohort Study" Diagnostics 12, no. 11: 2877. https://doi.org/10.3390/diagnostics12112877