Trends in flap reconstruction of pelvic oncologic defects: Analysis of the national inpatient sample

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2021-09, Vol.74 (9), p.2085-2094
• Main Authors: Zeiderman, Matthew R., Nuño, Miriam, Sahar, David E., Farkas, Linda M.
• Format: Article
• Language: English
• Subjects: Abdominoperineal resection; Adult; Anal cancer; carcinoma; Colon cancer; colorectal cancer; Female; Flap reconstruction pelvis; Humans; Length of Stay; Male; National inpatient sample; Nis; Pelvic Exenteration - adverse effects; Pelvic Neoplasms - surgery; Pelvic radiation; Pelvic reconstruction; Perineal reconstruction; Plastic Surgery Procedures - adverse effects; Plastic Surgery Procedures - methods; Plastic Surgery Procedures - trends; Postoperative Complications; Proctectomy - adverse effects; Rectal cancer; Retrospective Studies; Surgical Flaps - trends
• ISSN: 1748-6815; 1878-0539; 1878-0539
• DOI: 10.1016/j.bjps.2020.12.067

Flap reconstruction of radiated pelvic oncologic defects decreases perineal wound-healing complications. How widely and how often reconstructions are performed, and how technical mastery and improved perioperative care has affected outcomes, is unknown. Our objective is to 1) provide a comprehensive evaluation of national trends in flap reconstruction of pelvic oncologic defects and 2) compare complications and length of stay (LOS) in patients with/without reconstruction. The National Inpatient Sample (NIS) database was queried (1998–2014) for patients diagnosed with cancer, primarily of the rectum and anus, who underwent abdominoperineal resection (APR) or pelvic exenteration (PE). Differences in complications and LOS were compared between patients with flap reconstruction versus primary closure. Regional and hospital outcomes were also analyzed. The cohort included 117,923 adult patients; 3,673 (3.1%) underwent flap reconstruction. Flap reconstruction rates increased from 0.8% in 1998 to 9.8% in 2014. Extirpative procedures decreased 37.4% from 1998 to 2014. Flap reconstruction decreased risk of wound breakdown (OR 0.87; p = 0.0029) and need for secondary closure of dehiscence (OR 0.82; p = 0.0023) between periods 1998–2009 and 2010–2014. Median LOS was higher for flap patients (median [IQR] of 9.8 [7.2,14.8] vs. 7.9 [6.1–11.0; p