title: Unplanned reoperations after microvascular free tissue transfer: An analysis of 2,244 patients using the american college of surgeons national surgical quality improvement program database.
abstract: OBJECTIVE
  Our intent was to evaluate unplanned reoperations as a quality indicator for microvascular free tissue transfer (MFTT).
  
  
  METHODS
  The National Surgical Quality Improvement Program database was used to identify MFTT cases from January 2012 to December 2013. Multivariate logistic regression models were used to determine risk factors for unplanned reoperations.
  
  
  RESULTS
  We identified 2,244 MFTT cases. There were 290 associated unplanned reoperations (12.92%). There was a threefold increase in the rate of complications when patients underwent reoperation (58.28% vs 18.12%, p < 0.0001). Head and neck reconstructions had the highest rate of reoperations (18.04%). Most reoperations were debridements (38.28%), followed by microvascular procedures (28.97%) and flap revisions (26.55%). American Society of Anesthesiologist (ASA) classification ≥3 [OR 1.565, 95% CI (1.204, 2.034), p = 0.0008] and prolonged operative time [OR 1.597, 95% CI (1.221, 2.089), p = 0.0006] were significant independent risk factors for reoperations.
  
  
  CONCLUSIONS
  Unplanned reoperations are a useful quality indicator for MFTT. ASA classification ≥3 and prolonged operative time were risk factors associated with an increased risk for unplanned reoperations. © 2015 Wiley Periodicals, Inc. Microsurgery 37:184-189, 2017.
authors.affiliation: University of Utah, School of Medicine, Division of Plastic Surgery, 30 N 1900 E, 3B400, Salt Lake City, Utah, 84132.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Kwok
authors.affiliation: University of Utah, School of Medicine, Division of Plastic Surgery, 30 N 1900 E, 3B400, Salt Lake City, Utah, 84132.
authors.forename: Jayant P
authors.initials: JP
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000009:adverse effects* / Q000637:transplantation*; D006084:Graft Rejection; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008866:Microsurgery / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D058996:Quality Improvement; D012086:Reoperation / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States