{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T02:07:35Z","timestamp":1770775655658,"version":"3.50.0"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"02","funder":[{"name":"2022 JOBST Lymphatic Research Grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Older and frailer patients are increasingly undergoing free or pedicled tissue transfer for lower extremity (LE) limb salvage. This novel study examines the impact of frailty on postoperative outcomes in LE limb salvage patients undergoing free or pedicled tissue transfer.<\/jats:p><jats:p>\n          Methods\u2003The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2010\u20132020) was queried for free and pedicled tissue transfer to the LE based on Current Procedural Terminology and the International Classification of Diseases9\/10 codes. Demographic and clinical variables were extracted. The five-factor modified frailty index (mFI-5) was calculated using functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. Patients were stratified by mFI-5 score: no frailty (0), intermediate frailty (1), and high frailty (2\u2009+\u2009). Univariate analysis and multivariate logistic regression were performed.<\/jats:p><jats:p>\n          Results\u2003In total, 5,196 patients underwent free or pedicled tissue transfer for LE limb salvage. A majority were intermediate (n\u2009=\u20091,977) or high (n\u2009=\u20091,466) frailty. High frailty patients had greater rates of comorbidities\u2014including those not in the mFI-5 score. Higher frailty was associated with more systemic and all-cause complications. On multivariate analysis, the mFI-5 score remained the best predictor of all-cause complications\u2014with high frailty associated with 1.74 increased adjusted odds when compared with no frailty (95% confidence interval: 1.47\u20132.05).<\/jats:p><jats:p>\n          Conclusion\u2003While flap type, age, and diagnosis were independent predictors of outcomes in LE flap reconstruction, frailty (mFI-5) was the strongest predictor on adjusted analysis. This study validates the mFI-5 score for preoperative risk assessment for flap procedures in LE limb salvage. These results highlight the likely importance of prehabilitation and medical optimization prior to limb salvage.<\/jats:p>","DOI":"10.1055\/a-2102-0147","type":"journal-article","created":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T23:07:05Z","timestamp":1685142425000},"page":"163-170","source":"Crossref","is-referenced-by-count":9,"title":["Does Frailty Predict Outcomes in Patients Undergoing Free or Pedicled Flap Procedures for Lower Extremity Limb Salvage? An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database"],"prefix":"10.1055","volume":"40","author":[{"given":"Emmeline","family":"Jia","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon R.","family":"Garvey","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria P.","family":"Bustos","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Morgenstern","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosie","family":"Friedman","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard T.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arriyan S.","family":"Dowlatshahi","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan P.","family":"Cauley","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,7,12]]},"reference":[{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"440","DOI":"10.2337\/dci17-0005","article-title":"Diabetes and aging: unique considerations and goals of care","volume":"40","author":"R R Kalyani","year":"2017","journal-title":"Diabetes Care"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"346","DOI":"10.14423\/SMJ.0000000000000473","article-title":"Cardiovascular health status in baby boomers with diabetes mellitus","volume":"109","author":"D E King","year":"2016","journal-title":"South Med J"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1111\/j.1365-2648.2010.05568.x","article-title":"Quality of life in people with venous leg ulcers: an integrative review","volume":"67","author":"R V Gonz\u00e1lez-Consuegra","year":"2011","journal-title":"J Adv Nurs"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/iwj.12404","article-title":"The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review","volume":"13","author":"D C Jupiter","year":"2016","journal-title":"Int Wound J"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jval.2017.07.007","article-title":"An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds","volume":"21","author":"S R Nussbaum","year":"2018","journal-title":"Value Health"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1089\/wound.2019.0946","article-title":"Human wounds and its burden: an updated compendium of estimates","volume":"8","author":"C K Sen","year":"2019","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"335","DOI":"10.7547\/1000335","article-title":"The costs of diabetic foot: the economic case for the limb salvage team","volume":"100","author":"V R Driver","year":"2010","journal-title":"J Am Podiatr Med Assoc"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1055\/s-0038-1667363","article-title":"Limb salvage and functional outcomes following free tissue transfer for the treatment of recalcitrant diabetic foot ulcers","volume":"35","author":"J Lu","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1055\/s-0037-1621736","article-title":"Assessment of function after free tissue transfer to the lower extremity for chronic wounds using the lower extremity functional scale","volume":"34","author":"R A Falola","year":"2018","journal-title":"J Reconstr Microsurg"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/2000656X.2017.1285782","article-title":"Free flap reconstruction for diabetic foot limb salvage","volume":"51","author":"T Sato","year":"2017","journal-title":"J Plast Surg Hand Surg"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.bjps.2012.09.024","article-title":"Diabetic foot reconstruction using free flaps increases 5-year-survival rate","volume":"66","author":"T S Oh","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/SLA.0b013e3181b45598","article-title":"Redefining geriatric preoperative assessment using frailty, disability and co-morbidity","volume":"250","author":"T N Robinson","year":"2009","journal-title":"Ann Surg"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1100\/tsw.2001.58","article-title":"Accumulation of deficits as a proxy measure of aging","volume":"1","author":"A B Mitnitski","year":"2001","journal-title":"ScientificWorldJournal"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1471-2318-8-24","article-title":"A standard procedure for creating a frailty index","volume":"8","author":"S D Searle","year":"2008","journal-title":"BMC Geriatr"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jss.2013.01.021","article-title":"Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database","volume":"183","author":"V Velanovich","year":"2013","journal-title":"J Surg Res"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jamcollsurg.2017.11.005","article-title":"New 5-Factor Modified Frailty Index using American College of Surgeons NSQIP Data","volume":"226","author":"S Subramaniam","year":"2018","journal-title":"J Am Coll Surg"},{"issue":"08","key":"ref19","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1001\/jamaoto.2013.3969","article-title":"Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery","volume":"139","author":"P Adams","year":"2013","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"18","key":"ref20","doi-asserted-by":"crossref","first-page":"E1083","DOI":"10.1097\/BRS.0000000000003063","article-title":"The 5-Item Modified Frailty Index is predictive of severe adverse events in patients undergoing surgery for adult spinal deformity","volume":"44","author":"M Yagi","year":"2019","journal-title":"Spine"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"103121","DOI":"10.1016\/j.amjoto.2021.103121","article-title":"The modified 5-item frailty index is a predictor of perioperative risk in head and neck microvascular reconstruction: an analysis of 3795 cases","volume":"42","author":"A C Panayi","year":"2021","journal-title":"Am J Otolaryngol"},{"issue":"06","key":"ref22","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1016\/j.jvs.2015.12.023","article-title":"Validation of a modified Frailty Index to predict mortality in vascular surgery patients","volume":"63","author":"B A Ehlert","year":"2016","journal-title":"J Vasc Surg"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1055\/s-0042-1743566","article-title":"Frailty is the new age: a retrospective study of modified frailty index for preoperative risk assessment in autologous breast reconstruction","volume":"39","author":"A L Chow","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.jamcollsurg.2008.07.018","article-title":"Blueprint for a new American College of Surgeons: National Surgical Quality Improvement Program","volume":"207","author":"J D Birkmeyer","year":"2008","journal-title":"J Am Coll Surg"},{"issue":"12","key":"ref26","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1016\/j.injury.2018.08.017","article-title":"Frailty predicts mortality and complications in chronologically young patients with traumatic orthopaedic injuries","volume":"49","author":"R M Rege","year":"2018","journal-title":"Injury"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.jss.2020.03.052","article-title":"The 5-Item Modified Frailty Index predicts adverse outcomes in trauma","volume":"253","author":"B M Tracy","year":"2020","journal-title":"J Surg Res"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1080\/2000656X.2019.1688166","article-title":"Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases\u2020","volume":"54","author":"N G Cuccolo","year":"2020","journal-title":"J Plast Surg Hand Surg"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ejvs.2010.11.013","article-title":"A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes","volume":"41","author":"E J Fitzgerald O'Connor","year":"2011","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"11","key":"ref30","doi-asserted-by":"crossref","first-page":"2558","DOI":"10.1016\/j.injury.2016.09.010","article-title":"Microsurgical reconstruction for post-traumatic defects of lower leg in the elderly: a comparative study","volume":"47","author":"L Xiong","year":"2016","journal-title":"Injury"},{"issue":"07","key":"ref31","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1055\/s-0040-1710358","article-title":"Risk factors for lower extremity amputation following attempted free flap limb salvage","volume":"36","author":"W Piwnica-Worms","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1097\/PRS.0000000000007644","article-title":"Amputation versus free flap: long-term outcomes of microsurgical limb salvage and risk factors for amputation in the diabetic population","volume":"147","author":"V S Kotha","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref33","doi-asserted-by":"crossref","first-page":"2276","DOI":"10.1007\/s11999-014-3537-6","article-title":"Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction?","volume":"472","author":"M Innocenti","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"07","key":"ref34","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.bjps.2007.11.037","article-title":"Review of 197 consecutive free flap reconstructions in the lower extremity","volume":"61","author":"R Wettstein","year":"2008","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jss.2021.03.011","article-title":"The 5-Factor Modified Frailty Index as a predictor of 30-day complications in pressure ulcer repair","volume":"265","author":"J Luo","year":"2021","journal-title":"J Surg Res"},{"issue":"03","key":"ref36","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/bja\/aeq128","article-title":"Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery","volume":"105","author":"R J Wilson","year":"2010","journal-title":"Br J Anaesth"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.surg.2011.07.045","article-title":"Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery","volume":"150","author":"N E Mayo","year":"2011","journal-title":"Surgery"},{"issue":"08","key":"ref38","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1002\/micr.30810","article-title":"Using the modified frailty index to predict negative outcomes in free-flap breast reconstruction: a National Surgical Quality Improvement Project-based study","volume":"41","author":"N S Jain","year":"2021","journal-title":"Microsurgery"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2102-0147.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T16:27:21Z","timestamp":1730824041000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2102-0147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,26]]},"references-count":35,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2024,1,18]]},"published-print":{"date-parts":[[2024,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2102-0147","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,5,26]]},"published":{"date-parts":[[2023,5,26]]}}}