An analysis of free flap failure using the ACS NSQIP database. Does flap site and flap type matter?

PurposeWe sought to use the NSQIP database to determine the national rate and predictors of free flap failure based upon flap sites and flap types. MethodsFree 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. ResultsThere 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). ConclusionsRisk 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.