Socioeconomic disparities in access to flap reconstruction after oncologic lower extremity resection: A National Inpatient Sample analysis.

Abstract

Resection of lower extremity malignant tumors may create soft tissue defects that may benefit from flap reconstruction. Owing to the requirement for multidisciplinary surgical services, the utilization of this procedure may be affected by systemic barriers. This study incorporated a large national inpatient database to identify the drivers of such socioeconomic disparities. Lower extremity resection cases for malignant tumors were identified in the 2016-2022 National Inpatient Sample. A multivariable logistic regression model was used to evaluate independent predictors of flap reconstruction during admission. Nearest-neighbor propensity score matching was used to quantify the impact of flap reconstruction on the odds of wound-related complications (p<0.05). The final cohort included 11,635 cases. The overall rate of flap reconstruction was 25.4%. Preoperative radiation (OR: 1.55, 95% CI: 1.41-1.72, p<0.001), private insurance (OR: 1.20, 95% CI: 1.06-1.36, p=0.0030), and higher annual institutional plastic surgery volume (OR: 1.18, 95% CI: 1.14-1.23, p<0.001 per 100 cases) predicted higher odds of flap reconstruction. After propensity score matching, flap reconstruction was associated with lower odds of total wound-related complications during admission (OR: 0.82, 95% CI: 0.68-0.98, p=0.032). Socioeconomic factors drive disparities in receiving flap reconstruction after oncologic lower extremity resection. Flap reconstruction is associated with lower odds of short-term wound-related complications, emphasizing the importance of access to reconstructive services.