Intraoperative and postanesthesia care unit fluid administration as risk factors for postoperative complications in patients with head and neck cancer undergoing free tissue transfer

Abstract

Background: This study aims to evaluate the impact of perioperative fluid administration, defined as fluid delivered intraoperatively and in the postanesthesia care unit, on postoperative outcomes. Methods: Medical records of 102 patients with oral cavity squamous cell carcinoma undergoing free flap reconstruction between January 2011 and December 2015 were reviewed. The primary endpoint was development of a postoperative complication according to the Clavien-Dindo classification. Perioperative factors recorded were Washington University Head and Neck Comorbidity Index, operating time, vasopressor use, blood loss, intraoperative fluid, and perioperative fluid. Results: Greater perioperative fluid administration was independently associated with surgical complications, flap complications, overall incidence of any complication, and increased length of stay. Greater intraoperative fluid administration was independently associated with higher rates of surgical complications. Intraoperative delivery of vasopressors was not associated with flap or surgical complications. Conclusion: Receiving less perioperative fluid was associated with fewer complications and decreased length of stay. K E Y W O R D S free tissue transfer, head and neck cancer, intraoperative fluid, oral cavity squamous cell carcinoma, perioperative fluid, postanesthesia care unit, postoperative complication

Proposed Prediction Model and Nomogram for Systemic Complications in Patients Undergoing Free Flap Head and Neck Reconstruction

“…To date, the occurrence of PSCs associated with perioperative fluid overload in head and neck reconstruction has only been sparsely investigated. In a very recent study, no independent correlation was found between the amount of intraoperative or perioperative fluid administration and the occurrence of PSCs ( 15 ). Nevertheless, it is known from other studies that the increased application of crystalloids is associated with flap-specific complications by triggering inflammatory factors, increasing clotting rates, causing excessive oedema in the flap or swelling at the recipient site and mechanically stressing the pedicles ( 6 , 16 , 17 ).…”

Perioperative Tissue Oximetry-driven Fluid Resuscitation Improves Flap Perfusion in Autologous Free Tissue Breast Reconstruction

“…Several retrospective analyses of patients undergoing autologous reconstruction of the head and neck have also found decreased perioperative fluid to be associated with fewer complications and decreased length of stay. 18 , 19 It is important to note that underresuscitation has been found to be consequential in the perioperative period as well. In a review of 682 patients undergoing autologous breast reconstruction, Nelson et al 9 , 11 found that intraoperative underresuscitation increased the risk of postoperative flap thrombosis.…”

Bioelectrical Impedance Analysis in Patients Undergoing Major Head and Neck Surgery: A Prospective Observational Pilot Study

“…Similarly, Farwell et al [ 22 ] reported that patients with postoperative surgical complication had higher operative fluid administration with a median of 6600 mL compared to 3400 mL. Dooley et al [ 12 ] showed that not only intraoperative fluid administration is associated with surgical complications, but also the total fluid-administration volume, calculated as fluids administered in the operating room combined with fluids administered in the PACU. These were associated with postoperative surgical complications and therefore should be given with caution.…”

“…Recently, several studies have shown an association between perioperative high-volume fluid administration and postoperative complication rates in patients undergoing head and neck microvascular reconstruction [ 12 , 13 ].…”