title: An analysis of free flap failure using the ACS NSQIP database. Does flap site and flap type matter?
abstract: OBJECTIVE
  We sought to use the NSQIP database to determine the national rate and predictors of free flap failure based upon flap sites and flap types.
  
  
  METHODS
  Free flaps were identified using the 2005-2010 NSQIP database. We examined overall flap failure rates as well as failure rates based upon flap sites (head and neck, extremities, trunk, and breast) and flap types (muscle, fascial, skin, bone, and bowel flaps). Univariate and multivariate analyses were used to determine predictors of flap failure.
  
  
  RESULTS
  There were 1,187 microvascular free tissue transfers identified. The overall flap failure rate was 5.1%. Head and neck flaps had the highest rate of free flap failure at 7.7%. Prolonged operative time is an independent predictor of flap failure for all free flaps (OR: 2.383, P = 0.0013). When examining predictors of failure by flap site, free flaps to the breast with prolonged operative time are independently associated with flap failure (OR: 2.288, P = 0.0152). When examining predictors of flap failure by flap type, muscle based free flaps with an ASA classification ≥3 are associated with flap failure (P = 0.0441).
  
  
  CONCLUSIONS
  Risk factors for free flap failure differ based upon flap site and flap type. Prolonged operative time is an independent risk factor for the failure of free flaps used for breast reconstruction. An ASA classification ≥3 is associated with the failure of free muscle based flaps. Our findings identify actionable areas that may help to improve free flap success.
authors.affiliation: School of Medicine, Division of Plastic Surgery, University of Utah, 30 N 1900 E, 3B400, Salt Lake City, UT, 84132.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Kwok
authors.affiliation: School of Medicine, Division of Plastic Surgery, University of Utah, 30 N 1900 E, 3B400, Salt Lake City, UT, 84132.
authors.forename: Jayant P
authors.initials: JP
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000009:adverse effects* / Q000637:transplantation; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D011584:Psychology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment
keywords: NSQIP; flap failure; flap site; flap type; free flap