{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T07:22:48Z","timestamp":1769844168743,"version":"3.49.0"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003The rising clinical importance of assessing frailty is driven by its predictive capability for postoperative outcomes. This study assesses the effectiveness of RAI-rev (Revised Risk Analysis Index) in predicting adverse outcomes in lower extremity (LE) flap reconstruction.<\/jats:p><jats:p>\n          Methods\u2003Analyzing NSQIP (National Surgical Quality Improvement Program) data from 2015 to 2020, we compared demographics, perioperative factors, and 30-day outcomes in all locoregional and free-flap cases. Frailty scores, calculated using RAI-rev, were categorized with &lt;15 as nonfrail and &gt;35 as the most frail. Adjusted odds ratios (aORs) for specific complications were calculated using nonfrail as the reference group. Frailty scores in locoregional flaps were compared with those in free flaps.<\/jats:p><jats:p>\n          Results\u2003We identified 270 locoregional and 107 free-flap cases. Higher RAI-rev scores in locoregional flaps correlated with increased complications, such as deep surgical site infection (1% nonfrail vs. 20% RAI 31\u201335), stroke (0% nonfrail vs. 17% most frail), and mortality (0% nonfrail vs. 17% most frail). Locoregional flap cases with RAI-rev scores in the most frail group had a significantly elevated aOR for stroke (51.0, 95% confidence interval [CI]: 1.8\u20131402.5, p\u2009=\u20090.02), mortality (43.1, 95% CI: 1.6\u20131167.6, p\u2009=\u20090.03), and any complication (6.8, 95% CI: 1.2\u201337.4, p\u2009=\u20090.03). In free-flap cases, higher RAI-rev scores were associated with increased complications, with only sepsis showing a statistically significant difference (6% nonfrail vs. 100% most frail; aOR: 42.3, CI: 1.45\u20131245.3, p\u2009=\u20090.03). Free-flap cases had a significantly lower RAI-rev score compared with locoregional flap cases (14.91 vs. 17.64, p\u2009=\u20090.01).<\/jats:p><jats:p>\n          Conclusion\u2003Elevated RAI-rev scores (&gt;35) correlated with more complications in locoregional flaps, while free-flap reconstruction patients had generally low RAI-rev scores. This suggests that free flaps are less commonly recommended for presumed higher risk patients. The study demonstrates that RAI-rev may be able to serve as a risk calculator in LE reconstruction, aiding in the assessment of candidates for limb salvage versus amputation.<\/jats:p>","DOI":"10.1055\/a-2383-6916","type":"journal-article","created":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T23:35:36Z","timestamp":1723505736000},"page":"376-382","source":"Crossref","is-referenced-by-count":4,"title":["Effectiveness of Risk Analysis Index Frailty Scores as a Predictor of Adverse Outcomes in Lower Extremity Reconstruction"],"prefix":"10.1055","volume":"41","author":[{"given":"Kylie R.","family":"Swiekatowski","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose E.","family":"Barrera","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arvind D.","family":"Manisundaram","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohin A.","family":"Bhadkamkar","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1715-1097","authenticated-orcid":false,"given":"Yuewei","family":"Wu-Fienberg","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1089\/wound.2011.0309","article-title":"Free tissue transfer for limb salvage in high-risk patients: worth the risk","volume":"2","author":"M Endara","year":"2013","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1055\/a-2003-8789","article-title":"Outcomes of free muscle flaps versus free fasciocutaneous flaps for lower limb reconstruction following trauma: a systematic review and meta-analysis","volume":"39","author":"T Dow","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1001\/jamasurg.2016.4202","article-title":"Development and initial validation of the risk analysis index for measuring frailty in surgical populations","volume":"152","author":"D E Hall","year":"2017","journal-title":"JAMA Surg"},{"issue":"12","key":"ref4","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1007\/s00384-018-3163-y","article-title":"Frailty in surgical patients","volume":"33","author":"S JG Richards","year":"2018","journal-title":"Int J Colorectal Dis"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"136","DOI":"10.3171\/2023.2.SPINE221019","article-title":"Comparison of the Risk Analysis Index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery","volume":"39","author":"C A Bowers","year":"2023","journal-title":"J Neurosurg 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(2011-2020)","volume":"23","author":"M M Covell","year":"2023","journal-title":"Spine J"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"69S","DOI":"10.1016\/j.jvs.2013.02.120","article-title":"Predictors of 30-day readmission and postdischarge mortality following lower extremity amputation in the ACS-NSQIP","volume":"57","author":"T Curran","year":"2013","journal-title":"J Vasc Surg"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/j.jamcollsurg.2012.12.041","article-title":"Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures","volume":"216","author":"P J O'Brien","year":"2013","journal-title":"J Am Coll Surg"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1186\/s12871-022-01844-w","article-title":"The revised-risk analysis index as a predictor of major morbidity and mortality in older patients after abdominal surgery: a retrospective cohort study","volume":"22","author":"B Wei","year":"2022","journal-title":"BMC Anesthesiol"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1055\/a-2102-0147","article-title":"Does frailty predict outcomes in patients undergoing free or pedicled flap procedures for lower extremity limb salvage? 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The Adverse Discharge in Older Patients after Lower-extremity Surgery (ADELES) risk score","volume":"479","author":"M S Schaefer","year":"2021","journal-title":"Clin Orthop Relat Res"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.avsg.2022.04.007","article-title":"Increased frailty associated with higher long-term mortality after major lower extremity amputation","volume":"86","author":"J Cotton","year":"2022","journal-title":"Ann Vasc Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2383-6916.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T22:33:35Z","timestamp":1747089215000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2383-6916"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,12]]},"references-count":15,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2025,5,12]]},"published-print":{"date-parts":[[2025,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2383-6916","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":[[2024,8,12]]},"published":{"date-parts":[[2024,8,12]]}}}