Sarcopenia Best Predicts Complications in Free Flap Breast Reconstruction

Nirbhay S. Jain, MD; Elijah Bingham, BS; B. Kyle Luvisa, MD; Lynn M. Frydrych, MD; Madeline G. Chin, BA; Meiwand Bedar, MD, MSc; Andrew Da Lio, MD; Jason Roostaeian, MD; Christopher Crisera, MD; Ginger Slack, MD; Charles Tseng, MD; Jaco H. Festekjian, MD; Michael R. Delong, MD

doi:10.1097/GOX.0000000000005125

Plastic and Reconstructive Surgery, Global Open (Jul 2023)

Sarcopenia Best Predicts Complications in Free Flap Breast Reconstruction

Nirbhay S. Jain, MD,
Elijah Bingham, BS,
B. Kyle Luvisa, MD,
Lynn M. Frydrych, MD,
Madeline G. Chin, BA,
Meiwand Bedar, MD, MSc,
Andrew Da Lio, MD,
Jason Roostaeian, MD,
Christopher Crisera, MD,
Ginger Slack, MD,
Charles Tseng, MD,
Jaco H. Festekjian, MD,
Michael R. Delong, MD

Affiliations

Nirbhay S. Jain, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Elijah Bingham, BS: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
B. Kyle Luvisa, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Lynn M. Frydrych, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Madeline G. Chin, BA: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Meiwand Bedar, MD, MSc: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Andrew Da Lio, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Jason Roostaeian, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Christopher Crisera, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Ginger Slack, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Charles Tseng, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Jaco H. Festekjian, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.
Michael R. Delong, MD: From the Division of Plastic Surgery, University of California Los Angeles, Los Angeles, Calif.; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif.

DOI: https://doi.org/10.1097/GOX.0000000000005125
Journal volume & issue: Vol. 11, no. 7
p. e5125

Abstract

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Background:. Breast reconstruction remains a major component of the plastic surgeon’s repertoire, especially free-flap breast reconstruction (FFBR), though this is a high-risk surgery in which patient selection is paramount. Preoperative predictors of complication remain mixed in their utility. We sought to determine whether the sarcopenia score, a validated measure of physiologic health, outperforms the body mass index (BMI) and modified frailty index (mFI) in terms of predicting outcomes. Methods:. All patients with at least 6-months follow-up and imaging of the abdomen who underwent FFBR from 2013 to 2022 were included in this study. Appropriate preoperative and postoperative data were included, and sarcopenia scores were extracted from imaging. Complications were defined as any unexpected outcome that required a return to the operating room or readmission. Statistical analysis and regression were performed. Results:. In total, 299 patients were included. Patients were split into groups, based on sarcopenia scores. Patients with lower sarcopenia had significantly more complications than those with higher scores. BMI and mFI both did not correlate with complication rates. Sarcopenia was the only independent predictor of complication severity when other factors were controlled for in a multivariate regression model. Conclusions:. Sarcopenia correlates with the presence of severe complications in patients who undergo FFBR in a stronger fashion to BMI and the mFI. Thus, sarcopenia should be considered in the preoperative evaluation in patients undergoing FFBR.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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