The Controlling Nutritional Status (CONUT) Score for Prediction of Microvascular Flap Complications in Reconstructive Surgery

Rihards P Rocans; Janis Zarins; Evita Bine; Renars Deksnis; Margarita Citovica; Simona Donina; Biruta Mamaja

doi:10.3390/jcm12144794

The Controlling Nutritional Status (CONUT) Score for Prediction of Microvascular Flap Complications in Reconstructive Surgery

J Clin Med. 2023 Jul 20;12(14):4794. doi: 10.3390/jcm12144794.

Authors

Rihards P Rocans^{1

2}, Janis Zarins^{3

4}, Evita Bine¹, Renars Deksnis⁵, Margarita Citovica⁶, Simona Donina⁷, Biruta Mamaja²

Affiliations

¹ Intensive Care Clinic, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia.
² Department of Anaesthesia and Intensive Care, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia.
³ Department of Hand and Plastic Surgery, Microsurgery Centre of Latvia, Brivibas Street 410, LV-1024 Riga, Latvia.
⁴ Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Pulka Street 3, LV-1007 Riga, Latvia.
⁵ Surgical Oncology Clinic, Riga East Clinical University Hospital, Hipokrata Street 4, LV-1079 Riga, Latvia.
⁶ Laboratory Department, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia.
⁷ Institute of Microbiology and Virology, Riga Stradins University, Ratsupites Street 5, LV-1067 Riga, Latvia.

Abstract

Microvascular flap surgery is a widely acknowledged procedure for significant defect reconstruction. Multiple flap complication risk factors have been identified, yet there are limited data on laboratory biomarkers for the prediction of flap loss. The controlling nutritional status (CONUT) score has demonstrated good postoperative outcome assessment ability in diverse surgical populations. We aim to assess the predictive value of the CONUT score for complications in microvascular flap surgery. This prospective cohort study includes 72 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws for analysis of full blood count, total plasma cholesterol, and albumin concentrations were collected on the day of surgery before crystalloid infusion. Postoperative data on flap complications and duration of hospitalization were obtained. The overall complication rate was 15.2%. True flap loss with vascular compromise occurred in 5.6%. No differences in flap complications were found between different areas of reconstruction, anatomical flap types, or indications for surgery. Obesity was more common in patients with flap complications (p = 0.01). The CONUT score had an AUC of 0.813 (0.659-0.967, p = 0.012) for predicting complications other than true flap loss due to vascular compromise. A CONUT score > 2 was indicated as optimal during cut-off analysis (p = 0.022). Patients with flap complications had a longer duration of hospitalization (13.55, 10.99-16.11 vs. 25.38, 14.82-35.93; p = 0.004). Our findings indicate that the CONUT score has considerable predictive value in microvascular flap surgery.

Keywords: controlling nutritional status; microvascular flap complications; reconstructive surgery.

Grants and funding

The authors declare that Riga Stradiņš University kindly covered the publication fee for this article (Grant Reference Number 6-DN-20/2/2023). The funder was not involved in the study design, collection, analysis, interpretation of data or writing of this article.