Association between operation‐ and operator‐related factors and surgical complications among patients undergoing free‐flap reconstruction for head and neck cancers: A propensity score‐matched study of 1,865 free‐flap reconstructions

Abstract

Objective: Efforts have been devoted to clarify the possible factors related to postoperative complications in free-flap reconstruction. While patient-related factors have been widely discussed, studies regarding the operation/operatorrelated factors are rather limited in the literature. This study was designed to investigate the relationship between operation/operator-related factors and the surgical complications in free-flap reconstruction following head and neck cancer resection. Methods: Data of 1,841 patients with a total of 1,865 free-flap reconstructions (24 double free-flap reconstructions) between March 2008 and February 2017 were retrieved from the registered microsurgery database of the hospital. The association of operation/operator-related factors (including flap length and length-width ratio, flap types, use of vein graft, opposite side microanastomosis, number of microanastomoses, operators, operator experience, and operation time) with surgical complications was assessed by 1:1 propensity score-matched study groups.Results: After propensity score matching of the patient-related factors, the rate of vein grafting was significantly higher (0.6% vs. 2.2%, p = .038) and the operation time was longer (7.0 [5.8-8.5] vs. 7.4 [6.1-8.8] hr, p = .006) in the complication group. In addition, flap length and length-width ratio, flap types, opposite side microanastomosis, number of microanastomoses, operators, and operator experience were not associated with surgical complications. Conclusions:In a hospital that consisted of surgeons with high-volume or very-highvolume experience, the operators or operation experience were not significantly associated with the surgical complications. Only a longer operation time was associated with surgical complications in the patients who underwent free-flap reconstruction for head and neck cancer.

Advantages of the scapular system in mandibular reconstruction

“…One of the most‐often cited disadvantages of the SFF is prolonged operative time 2,8 . Several studies have described the association of increased operative time with surgical complications including flap failure as well as medical complications 13–15 . In this study, we found that when using the two‐team supine approach as described by Eskander et al, the SFF does not require significantly more time to complete 16 .…”

“…2,8 Several studies have described the association of increased operative time with surgical complications including flap failure as well as medical complications. [13][14][15] In this study, we found that when using the two-team supine approach as described by Eskander et al, the SFF does not require significantly more time to complete. 16 We do acknowledge that this approach may be more difficult in obese patients and requires excellent team cooperation.…”

Comparison of the surgical outcomes of free flap reconstruction for primary and recurrent head and neck cancers: a case-controlled propensity score-matched study of 1,791 free flap reconstructions

“…The use of vein grafts has been associated with significantly higher flap losses than those with direct microanastomosis 29 . Although the most common scenario in which vein grafting is required is the lack of nearby or even ipsilateral healthy recipient vessels, and such conditions were generally encountered in those who had a prior failed reconstruction, a repeated cancer resection, or those who already received radical neck dissection or radiotherapy 16 . However, in this study, there was no significant difference of vein graft use between those who had primary or recurrent cancers either before or after propensity score matching.…”

The Impact of Healthcare-Associated Infections in Patients Undergoing Oncological Microvascular Head and Neck Reconstruction: A Prospective Multicentre Study

“…In addition, the surgery duration in our series was also significantly related to the risk of infection, with a median duration of 1 h and a half longer for the group suffering HAIs. Other authors have also demonstrated this relationship in patients with free-flap head and neck reconstruction [37,39]. These two findings-a high rate of free-flap failure and prolonged duration of surgery-should be areas for improvement.…”