Perioperative Predictors of Free Flap Damage in Head and Neck Surgery

A Retrospective Cohort Study

Authors

  • Maria Ana Máximo Hosp Prof Doutor Fernando Fonseca E.P.E.
  • Sara Serafino
  • Susana Carvalho

DOI:

https://doi.org/10.25751/rspa.17233

Keywords:

Anesthesia; Body Mass Index; Free Tissue Flaps; Head and Neck Neoplasms/surgery; Postoperative Complications; Reconstructive Surgical Procedures/adverse effects

Abstract

Introduction: Microvascular free flap surgery improves survival and life quality. However, we lack knowledge on the best anesthesia approach. We aimed to identify predictors of flap damage.

Material and Methods: Eighty-seven patients submitted to head and neck free flap surgery were analyzed. The primary endpoint was flap damage (composite of complete flap loss, wound infection and 30-day re-intervention).

Results: Flap damage occurred in 18.6% patients (n=16). Body mass index was significantly different between groups. Patients with flap damage had a median body mass index of 20.56 [IQR 4.01] compared to 22.03 [IQR 5.02] in the control group. Body mass index had a significant discriminatory power for predicting flap damage (AUC 0.67 CI: 0.54-0.81). With a cut-off body mass index of 21, lower body mass index patients were at increased risk for flap damage (OR 3.96; CI: 1.24-12.69). They were more frequently mechanically ventilated >48 hours (56.3% vs 17.4%, p<0.05) or received postoperative blood transfusion (56.3% vs 20,3%, p <0.05). They had longer ICU (6.5 IQR 6 vs 4 IQR 4, p <0.05) and in-hospital stays (37.5 IQR 36 vs 18 IQR 17, p<0.05).

Discussion: Nutritional status should be a priority during patient selection. The association to mechanical ventilation, postoperative blood transfusion and prolonged in-intensive care unit stays reinforces
the need for optimal postoperative care.

Conclusion: Body mass index, mechanical ventilation, postoperative blood transfusion, longer intensive care unit and in-hospital stays were predictors of flap damage. Anesthesiologists should assume a coordinated perioperative medicine. Further studies are needed to clarify relevant practices.

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Published

2019-09-02

How to Cite

Máximo, M. A., Serafino, S., & Carvalho, S. (2019). Perioperative Predictors of Free Flap Damage in Head and Neck Surgery: A Retrospective Cohort Study. Journal of the Portuguese Society of Anesthesiology, 28(3), 161–166. https://doi.org/10.25751/rspa.17233

Issue

Vol. 28 No. 3 (2019): Revista da Sociedade Portuguesa de Anestesiologia

Section

Original Article

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