American Association of Plastic Surgeons

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The Impact of Diabetes on Free Flap Outcomes: Analysis of 6,030 Patients.
Rami S. Kantar, MD, William J. Rifkin, BA, Joshua A. David, BS, Michael J. Cammarata, BS, J. Rodrigo Diaz-Siso, MD, Alyssa R. Golas, MD, Jamie P. Levine, MD, Daniel J. Ceradini, MD.
New York University Langone Health, New York, NY, USA.

PURPOSE: Diabetes affects a significant proportion of the population in the United States. Microsurgical procedures are common in this patient population, including free flap reconstruction. However, there are few large-scale studies evaluating the direct association between diabetes and outcomes following free flap reconstruction.
METHODS: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify patients undergoing free flap microsurgical reconstruction between 2010 and 2015. Preoperative variables and outcomes were compared between diabetic and non-diabetic patients. Chi-square analysis and Fisher's exact test were used for categorical variables and t tests for continuous variables. Multivariate regression was performed to control for potential confounders.
RESULTS: Database review identified 6,030 eligible patients. Diabetic patients presented significantly higher rates of wound complications, including deep incisional surgical site infection (SSI) (OR=1.35; p=0.01) and wound dehiscence (OR=1.17; p=0.03). No significant difference in flap failure was observed. Diabetic patients also presented a significantly longer hospital length of stay (LOS) (B=0.62; p<0.001).
CONCLUSION: Our study evaluated the largest national cohort of free flap procedures. These results suggest that diabetic patients are at significantly higher risk of postoperative deep incisional (SSI), wound dehiscence and longer LOS. However, importantly diabetes was not associated with increased rates of flap failure. Our findings highlight the critical need for heightened clinical vigilance and wound care in the diabetic patient population following free flap reconstruction for optimal outcomes.


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