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J Reconstr Microsurg
DOI: 10.1055/a-2491-3564
Original Article

Sociodemographic Status Impacts Ambulatory Outcomes in Lower Extremity Flap Reconstruction

Eloise W. Stanton 
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
2   Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, California
,
Artur Manasyan
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
2   Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, California
,
Idean Roohani
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
2   Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, California
,
Erin Wolfe
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
,
David A. Daar
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Joseph N. Carey
1   Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
› Author Affiliations Funding None.
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Abstract

Background There is a lack of literature regarding the effects of language barriers, socioeconomic status, racial disparities, and travel distance to the hospital on the outcomes of lower extremity (LE) flap reconstruction. Consequently, this study assesses the potential influence of these factors on ambulation within this specific patient demographic.

Methods A retrospective review was performed between 2007 and 2022 of patients who underwent LE reconstruction with tissue flap placement at a single institution. The primary outcome was ambulation status, with cohorts compared between those who were ambulatory versus nonambulatory. Covariates included race, age, gender, primary language, distance from patient home to hospital, socioeconomic status (determined using area deprivation index [ADI]), and flap characteristics. Outcomes were assessed with multivariable logistic regression.

Results A total of 242 patients who underwent LE flap reconstruction during the study period. The average time to final ambulatory status was 7.0 months (standard deviation: 11.0), with 51.7% requiring either a wheelchair or assistance device and 48.4% being fully ambulatory at final follow-up. The average state ADI for the cohort was 5.8, with Hispanic patients having significantly higher deprivation indexes (6.3 vs. 5.6, p < 0.001). Multiple logistic regression demonstrated that when controlling for numerous covariates, patients in the highest 15th percentile of deprivation were significantly less likely to be fully ambulatory at final follow-up (odds ratio: 0.22, 95% confidence interval: 0.061–0.806, p = 0.022).

Conclusion The current study emphasizes the substantial impact of socioeconomic disparities on postoperative outcomes in LE flap reconstruction. The finding that patients in the highest 15th percentile of deprivation were less likely to achieve full ambulation underscores the need to prioritize socioeconomic factors in clinical consideration and highlights a crucial avenue for future research.

Keywords

lower extremity - trauma - reconstruction - socioeconomic disparities - deprivation


Publication History

Received: 08 August 2024

Accepted: 23 November 2024

Accepted Manuscript online:
28 November 2024

Article published online:
26 December 2024

© 2024. Thieme. All rights reserved.

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