Prediction Of Adverse Outcomes Following Free Tissue Transfer Using Lace Index For The Treatment Of Chronic Lower Extremity Wounds
Zoe K. Haffner, BS1, Areeg A. Abu El Hawa, BS2, Kunal M. Kirloskar, MS2, Connor Lester, BS2, Abigail R. Tirrell, BS2, Kevin G. Kim, BS1, Paige K. Dekker, BA2, Jenna C. Bekeny, MD1, Kenneth L. Fan, MD1, Karen K. Evans, MD1.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA.
PURPOSE: As healthcare costs rise, scales that predict hospital readmission are needed to identify at-risk patients. The LACE Index is used to predict readmission and mortality within 30 days of discharge. LACE has been studied in plastic surgery populations, but evidence among specific cohorts is lacking. Our aim was to evaluate the utility of LACE in patients undergoing free tissue transfer (FTT) to the lower extremity (LE), a population at high risk of poor outcomes.
METHODS: Patients undergoing FTT for chronic LE wounds at our institution between 2013 and 2019 were included. Retrospective chart review was performed for univariate analysis and to calculate LACE Index. Outcomes were defined as emergency department (ED) and inpatient admissions, re-operation, and mortality within 30 and 90 days of discharge.
RESULTS: 170 patients were included in our analysis. Post-hoc multivariable logistic regression including age, previous admissions, and different LACE score thresholds found LACE ≥11 was significantly associated with higher odds of 90-day ED admission (OR: 2.424, p=0.023). No association was found between LACE and inpatient readmission or re-operation (Table 1). No patients died within the follow-up period.
CONCLUSION: Our analysis demonstrates that certain LACE Index score cut-offs may predict 90-day ED admissions, but LACE may not be suitable to predict readmission following LE FTT. Further studies should ascertain whether LACE is an important risk stratification tool for patients undergoing FTT.
| Overall | ED Admission within 30 Days | ED Admission within 90 Days | Inpatient Readmission within 30 Days | Inpatient Readmission within 90 Days | Re-operation within 30 Days | Re-operation within 90 Days | |
| Age (years) | 55.6 ± 14.7 | OR: 0.980 p=0.150 | OR: 0.974 p=0.028 | OR: 0.974 p=0.085 | OR: 0.980 p=0.079 | OR: 0.987 p=0.379 | OR: 0.991 p=0.446 |
| Diabetes | 84 (49.4%) | OR: 2.659 p=0.034 | OR: 2.242 p=0.026 | OR: 2.659 p=0.034 | OR: 3.120 p=0.003 | OR: 1.267 p=0.606 | OR: 1.923 p=0.065 |
| BMI (kg/m2) | 29.5 ± 6.6 | OR: 1.058 p=0.058 | OR: 1.025 p=0.346 | OR: 1.087 p=0.004 | OR: 1.077 p=0.004 | OR: 1.059 p=0.071 | OR: 1.036 p=0.176 |
| Inpatient Admission in the last year | 79(47.5%) | OR: 1.371 p=0.058 | OR: 1.356 p=0.044 | OR: 1.004 p=0.982 | OR: 1.160 p=0.329 | OR: 1.050 p=0.808 | OR: 1.191 p=0.243 |
| Length of Stay (days) | 27.9 ± 14.0 | OR: 1.005 p=0.726 | OR: 1.008 p=0.483 | OR: 1.001 p=0.938 | OR: 1.021 p=0.083 | OR: 0.993 p=0.683 | OR: 1.002 p=0.846 |
| Post-operative Day of Discharge | 16.1 ± 9.8 | OR: 0.999 p=0.998 | OR: 0.992 p=0.684 | OR: 0.996 p=0.860 | OR: 1.021 p=0.204 | OR: 0.976 p=0.417 | OR: 0.998 p=0.906 |
| LACE Score | 12 (IQR:10-15) | OR: 1.051 p=0.444 | OR: 1.101 p=0.361 | OR: 1.030 p=0.444 | OR: 1.096 p=0.804 | OR: 0.907 p=0.446 | OR: 0.999 p=0.720 |
| LACE ≥10 (Multivariable Logistic Regression) | - | - | OR: 1.514 p=0.326 | OR: 1.395 p=0.514 | OR: 1.063 p=0.878 | - | - |
| LACE ≥11 (Multivariable Logistic Regression) | - | - | OR: 2.424 p=0.023 95% CI: 1.13-5.21 | OR: 1.785 p=0.194 | OR: 1.857 p=0.093 | - | - |
Back to 2022 Posters