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Diabetes is not associated with increased rates of free flap failure: Analysis of outcomes in 6030 patients from the ACS‐NSQIP database
Author(s) -
Kantar Rami S.,
Rifkin William J.,
David Joshua A.,
Cammarata Michael J.,
DiazSiso J. Rodrigo,
Levine Jamie P.,
Golas Alyssa R.,
Ceradini Daniel J.
Publication year - 2019
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30332
Subject(s) - medicine , diabetes mellitus , dehiscence , confounding , population , surgery , wound dehiscence , multivariate analysis , cohort , univariate analysis , cohort study , emergency medicine , environmental health , endocrinology
Background Diabetes affects a significant proportion of the population in the United States. Microsurgical procedures are common in this patient population, and despite many conflicting reports in the literature, there are no large studies evaluating the direct association between diabetes and outcomes, specifically failure, following free flap reconstruction. In this study, we sought to determine the impact of diabetes on postoperative outcomes following free flap reconstruction using a national multi‐institutional database. Methods We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) database to identify patients undergoing free flap reconstruction from 2010 to 2015. Preoperative variables and outcomes were compared between diabetic and nondiabetic patients. Univariate and multivariate analyses were performed to control for confounders. Results We identified 6030 eligible patients. No significant difference in flap failure rates was observed. However, diabetic patients presented significantly higher rates of wound complications, including deep incisional surgical site infection (SSI) (OR = 1.35; P = .01) and wound dehiscence (OR = 1.17; P = .03). Diabetic patients also presented a significantly longer hospital length of stay (LOS) (β = .62; P < .001). Conclusions Our study evaluated the largest national cohort of free flap procedures. These results suggest that diabetes is not associated with increased rates of flap failure. However, diabetic patients are at significantly higher risk of postoperative deep incisional SSI, wound dehiscence, and longer LOS. Our findings provide the most concrete evidence to date in support of free flap reconstruction in diabetic patients, but highlight the need for heightened clinical vigilance and wound care for optimal outcomes.