D2. Times Have Changed: A Nationwide Analysis of Outcomes and Costs Associated with Early vs. Late Free Flap Reconstruction following Lower Extremity Trauma in 698 Patients

Abstract

PURPOSE: For over 35 years the Godina Principle has governed the timing of free flap reconstruction (FFR) after lower extremity (LE) trauma. We aim to reevaluate the timing of LE FFR within 72 hours of injury. METHODS: The Nationwide Readmission Database (2015-2019) was queried for all admissions with acute LE trauma who received FFR. The association between flap timing and complications, readmissions, and costs was analyzed using risk-adjusted analyses. RESULTS: A total of 698 patients undergoing FFR after LE trauma were identified. Timing of FFR was stratified by immediate (0-72 hours), delayed (72 hours-10 days), and late (10+ days). Delay of FFR was not associated with increased risk of amputation or 30-day readmissions for surgical complications, surgical site infection (SSI), or any other complications. Delayed FFR was associated with higher predicted length of stay (LOS) (2.9 days, P=0.048) after FFR but not increased cost (P=0.628). Late FFR was also associated with increased LOS post FFR (6.11 days, P=0.032) but cost was again similar (P=0.641). CONCLUSION: Delay of FFR does not appear to increase risk of amputation, surgical complications, SSI, readmissions, or costs. Despite increased LOS, patients can benefit from FFR regardless of transfer delays to microsurgery-capable centers. Patients who previously were not considered candidates, may now be well-suited for FFR, resulting in improved psyche, quality of life, and societal re-integration.