Association of Smoking Tobacco With Complications in Head and Neck Microvascular Reconstructive Surgery

Abstract

IMPORTANCE Smoking is a highly prevalent risk factor among patients with head and neck cancer. However, few studies have examined the association of this modifiable risk factor on postoperative outcomes following microvascular reconstruction of the head and neck.OBJECTIVE To analyze the risk associated with smoking in patients undergoing free flap surgery of the head and neck.DESIGN, SETTING, AND PARTICIPANTS In this retrospective, population, database study, the National Quality Improvement Program data sets from 2005 to 2014 were queried for all cases of head and neck surgery involving free flap reconstruction in the United States. The 2193 cases identified were stratified into smoking and nonsmoking cohorts and compared using χ 2 and binary logistic regression analyses. Pack-years of smoking data were used to assess the degree of risk associated with a prolonged history of smoking. All analyses were conducted between January 2018 and June 2018.MAIN OUTCOMES AND MEASURES Smoking and nonsmoking cohorts were compared for rates of demographic characteristics, comorbidities, and complications. Following correction for differences in patient demographics and comorbidities, smoking and nonsmoking cohorts were compared for rates of postoperative complications. Complication rates were further assessed within the smoking cohort by number of pack years smoked. RESULTSOf the 2193 patients identified as having undergone free flap reconstruction of the head and neck, 624 (28.5%) had a history of recent smoking. After accounting for differences in demographic variables and patient comorbidities using regression analyses, smoking status was found to be independently associated with wound disruption (odds ratio, 1.74; 95% CI, 1.17-2.59; P = .006) and unplanned reoperation (odds ratio, 1.50; 95% CI, 1.15-1.95; P = .003). An analysis by pack-years of smoking showed that a longer smoking history was significantly associated with higher rates of numerous comorbidities but not with a corresponding increase in rates of complications.CONCLUSIONS AND RELEVANCE Smokers undergoing free flap reconstruction of the head and neck may be at significantly higher risk of postoperative wound disruption and subsequent reoperation. These risks were independent of pack-years of smoking history, suggesting that both risks were associated with perioperative smoke exposure, and preoperative smoking cessation may be of benefit.LEVEL OF EVIDENCE NA.

Impact of neoadjuvant chemotherapy on perioperative morbidity after major surgery for head and neck cancer

“…The overall complication rate in the current study was 22.7% for the entire cohort, which compares favorably with a 28.2% overall complication rate reported in a study of 2193 patients with HNC using NSQIP data from multiple institutions. 15 This study reported a wound complication rate of approximately 16.7% to 20.8% and a URTOR rate of approximately 18.0% to 24.8%, similar to the wound complication rate of 17.0% and URTOR rate of 15.2% reported in the current study. Another institutional series reported an overall complication rate of 32.4%, although it should be noted that the complications were reported using the Clavien-Dindo grading system and included blood transfusion as part of the complication rate.…”

“…Although some series have shown that smoking is associated with higher rates of surgical and medical complications, 27,28 other studies regarding head and neck surgical resection and free-flap reconstruction have not found smoking to be a significant independent predictor of surgical complications. 15,29 Last, prior disease or receipt of RT were not found to significantly increase the risk of overall or wound complications on univariate analysis or in multivariate models, which other studies similarly have found. 30,31 Multivariate analysis of LOS demonstrated that only UADT surgery, compared with cutaneous surgery, was an independent predictor.…”

Anesthesia for Reconstructive Surgery of Head and Neck.

“…Two recent studies have studied the impact of age on reconstructive head and neck surgery. The first of these J ENT Care Otolaryngol Res is a retrospective study in which 132 cases were reviewed, two groups of patients older or younger than 80 years [53]. The second study had a prospective design with cases and controls, with an N = 14 in each branch differentiated by age: older or younger than 90 years [54].…”

Prehabilitation and Optimization of Modifiable Patient Risk Factors: The Importance of Effective Preoperative Evaluation to Improve Surgical Outcomes

“…Active smokers are more likely to experience postoperative total joint replacement infection, necessitating reoperation . Smokers also have a higher incidence of failure in cervical and lumbar surgeries, higher incidences of incision site disruption and reoperation in head and neck cancer surgery, and poorer outcomes in a variety of other surgical procedures.…”