Why the study?
Flap-related vascular complications requiring surgical reintervention cause morbidity after microsurgical free flap reconstruction, and preoperative risk estimation currently relies on clinical judgement.
Population
650 consecutive adults (649 analysable) undergoing microsurgical free flap reconstruction at two high-volume referral centres
Design
Retrospective cohort study
Follow-up
30 days
Key result
A preoperative XGBoost model predicted unplanned surgical reintervention within 30 days after free flap reconstruction with an AUC of 0.84 (95% CI 0.74-0.92).
Authors
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May inform preoperative flap re-exploration risk; leaves open external validation before clinical use.
Cohort (n=649)
Yes
Effect estimate: AUC 0.84 (95% CI 0.74-0.92)
An XGBoost-based preoperative risk model demonstrated good discrimination (AUC 0.84) for predicting unplanned surgical reintervention after microsurgical free flap reconstruction, though external validation is needed.
Laguna et al. (2026) conducted a cohort in microsurgical free flap reconstruction (n=649). Preoperative multivariable risk model (XGBoost) vs. Random forest and LASSO was evaluated on unplanned re-exploration within 30 days for arterial, venous, mixed thrombosis, or clinically significant vasospasm (AUC 0.84, 95% CI 0.74-0.92). A preoperative XGBoost model predicted unplanned surgical reintervention within 30 days after free flap reconstruction with an AUC of 0.84 (95% CI 0.74-0.92).
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