Development and validation of a healthy lifestyle and behavioral score for predicting metabolic syndrome: evidence from a 24-year longitudinal health check-up cohort in Taiwan.

Pressure injuries (PIs) are increasingly prevalent secondary complications of spinal cord injury or disorder (SCI/D), profoundly affecting individuals’ quality of life with significant cost to the health system [–]. PIs are classified according to the National Pressure Injury Advisory Panel (NPIAP) staging system [] with stage 1 and 2 often managed conservatively, whilst surgical management involving debridement and flap surgery is generally required for more complex stage 3 and 4 PIs []. Flap surgery for management of PIs often involves local axial-pattern flaps with a well-defined blood supply []. These are categorised as fasciocutaneous, which comprise skin, subcutaneous tissue and deep fascia; or myocutaneous flaps, involving the skin, subcutaneous and deep fascia, and underlying muscle [, ]. Documented complication rates following flap surgery vary between 21–74%, with complications often prolonging the length of stay (LoS) [–]. Local complications include wound dehiscence, infection, necrosis, haemorrhage, seroma, and sepsis from local infection [, , –]. Existing research has focused on the surgical wound which may overlook more general complications that influence post-surgical recovery and wound healing, including anaemia, sepsis, pneumonia, or new hospital-acquired PIs []. Whilst some previous research examines factors such as multidisciplinary (MD) postoperative management, risk screening, nutritional optimisation, spasticity management, and education, there is little evidence supporting the reduction in post-flap surgery complications associated with these strategies []. Very few studies have explored the risk factors that predispose individuals to develop such complications. Meticulous, specialist surgical and rehabilitation management following flap surgery is crucial and whilst postoperative management protocols differ, they generally include a period of strict bed rest, between 2–8 weeks, followed by graded return to sitting and activities of daily living [, , , ]. Anecdotal evidence from the Spinal Injuries Unit (SIU) where this study was undertaken suggested concerning complication rates, with general complications often prolonging postoperative recovery, rehabilitation and LoS. Discharge delays are worrying and people with SCI/D describe the postoperative period as extremely “confining” due to prolonged LoS and social isolation, resulting in grief, depression and poorer adherence with treatment [, ]. Therefore, the current study aimed to: 1) comprehensively describe the range of local and general complications occurring in individuals with SCI/D following flap surgical repair for PI; and 2) examine potential factors contributing to post-surgery complications.