National trends in utilization and timing of flap reconstruction for lower extremity Gustilo-Anderson III fractures: A National Inpatient Sample analysis.

Abstract

Recent research has suggested that the timing of successful flap reconstruction for lower extremity Gustilo-Anderson III fractures may be extended past 72 h of injury. This analysis incorporated a national database to assess the trends in flap reconstruction and relationship between reconstruction timing and short-term postoperative complications. Admissions for lower extremity Gustilo-Anderson III fractures were identified in the 2016-2022 National Inpatient Sample. The main outcomes of interest were reconstruction using either pedicled or free flap and occurrence of in-hospital wound-related complications. Multivariable logistic regression models were used to evaluate the predictors of flap reconstruction and effect of reconstruction timing on the likelihood of in-hospital complications (p < 0.05). The final cohort included 58,580 cases. Flap reconstruction was performed in 3830 (6.5%) cases. Lower median neighborhood income (odds ratio [OR]: 0.89, 95% confidence interval [CI]: 0.80-0.99, p = 0.031) predicted lower odds of flap reconstruction, whereas higher institutional plastic surgery volume conferred higher odds (OR: 1.23, 95% CI: 1.19-1.27, p < 0.001 per 100 cases). Flap reconstruction performed 4-7 days after admission predicted similar odds (OR: 1.31, 95% CI: 0.79-2.17, p = 0.29) of developing postoperative complications when compared to reconstruction within 3 days. Free flaps did not predict significantly different odds of complications when compared to pedicled flaps (OR: 1.02, 95% CI: 0.77-1.35, p = 0.88). Socioeconomic and clinical factors were found to be the predictors of flap reconstruction after complex lower extremity injuries. Flap reconstruction within the first 3 days after admission continues to have the lowest rates of wound-related complications; however, our findings indicate that reconstruction up to 7 days carries similar risk of in-hospital complications.