Variables associated with patient-reported outcomes and their trajectories following lower extremity free flap reconstruction

Background: Knowledge of potentially modifiable variables influencing the recovery and the trajectory of recovery after lower limb salvage with free flap reconstruction might aid in improving outcomes and support targeted rehabilitation strategies. Therefore, we asked: (1) what variables are independently associated with capability, quality of life, and discomfort, and their trajectory? (2) Is there a difference in recovery trajectories between specific capability tasks? Methods: Patients who were enrolled in the “Dangle study” and underwent lower extremity free flap reconstruction at four Dutch academic medical centers were invited to complete patient-reported outcome measures. Capability was assessed using PROMIS Physical Function – Mobility, quality of life using the EQ-5D-5 L, and discomfort using a numerical visual analogue scale (VAS). Questionnaires were completed at various times after surgery. Linear mixed-effects models were used to account for the repeated measures design. Results: Fifty-one participants completed 113 questionnaires. Male sex and the absence of diabetes were independently associated with greater capability, but not with recovery trajectories. Only time since reconstruction was independently associated with greater quality of life. Reconstructions of the foot were associated with increased levels of discomfort compared to lower leg reconstructions, but not with the trajectory of discomfort. Individual capability subscales demonstrated largely stable recovery trajectories without clinically meaningful differences between tasks. Conclusion: Although the variables identified are mostly non-modifiable, they can inform appropriate expectations before and after deciding on limb salvage. In addition, they can help identify people at greater risk for reduced recovery, who might benefit from targeted interventions such as the integrated involvement of rehabilitation, mental health, and pain management services.