Postoperative complications after head and neck operations that require free tissue transfer - prevalent, morbid, and costly

McMahon, Jeremy; Handley, T.P.B.; Bobinskas, Alexander M.; Elsapagh, M.; Anwar, Hamza; Ricciardo, Peter; McLaren, Alistair; Davis, Rowan; Syyed, N.; MacIver, Colin; Wales, Craig; Hislop, W.S.; Thomson, Ewen; Thomson, Stephen; Fitzpatrick, Kevin; Rae, Alan P.; Campbell, Rebecca A.

doi:10.1016/j.bjoms.2017.07.015

Cited by 40 publications

(31 citation statements)

References 12 publications

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“…The reported impact of postoperative complications on survival and mortality after free flap surgery for cancer of the head and neck has varied in previous studies. 5,16,17 Unlike the present study, the recent prospective trial by McMahon et al did not analyze the onset of complications on outcome. 17 Here we reported the significant effect of late complications on mortality, which has not been analyzed before.…”

Section: Discussionmentioning

confidence: 64%

“…5,16,17 Unlike the present study, the recent prospective trial by McMahon et al did not analyze the onset of complications on outcome. 17 Here we reported the significant effect of late complications on mortality, which has not been analyzed before. Medical complications, more advanced cancer (N-score >2) and readmission to ICU were all associated with worsened one-year survival.…”

Section: Discussionmentioning

confidence: 64%

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Complications and outcome after free flap surgery for cancer of the head and neck

Lahtinen

Koivunen

Ala‐Kokko

et al. 2018

British Journal of Oral and Maxillofacial Surgery

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We retrospectively studied 136 patients who had free flap reconstruction for cancer of the head and neck at a single centre (2008-2015) to evaluate complications, assess factors associated with them, and analyse their impact on outcome. Preoperative and perioperative data, and surgical and medical complications were recorded, and the impact of the complications on duration of hospital stay and survival were assessed. A total of 86 (63%) patients had complications. Compared with those who did not, they had a higher rate of alcohol abuse (21/86, compared with 5/50, p=0.039), longer operations (median (IQR) 565 (458-653 compared with 479 (418-556) minutes, p<0.001), and greater intraoperative loss of blood (725 (400-1150) compared with 525 (300-800) ml, p=0.042). Complications were more common in patients who had fibular flaps and T4 disease (22/86 compared with 4/50, p=0.010; 47/80 compared with 16/47, p=0.015, respectively). Those who had complications also stayed in hospital longer (median (IQR) 9 (7-12) compared with 15 (10-21) days, p<0.001). Cumulative mortality was higher in patients with late complications (those that occurred after the fourth postoperative day) (61% compared with 36%, p=0.004). In conclusion, complications in more than half the patients were related to alcohol abuse, a more complicated intraoperative course, and fibular flaps. Complications were associated with a longer hospital stay, and survival was higher in those who did not have late complications than in those who did.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 64%

Complications and outcome after free flap surgery for cancer of the head and neck

Lahtinen

Koivunen

Ala‐Kokko

et al. 2018

British Journal of Oral and Maxillofacial Surgery

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“…However, a formal statistical analysis was not performed comparing the pre‐ and post‐ERAS groups. McMahon et al also implemented a similar ERAS protocol but did not show a statistically significant reduction in hospital length of stay . The authors did not measure compliance in the protocol, making it difficult to ascertain the etiology for the lack of an observed reduction.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery in head and neck surgery: Reduced opioid use and length of stay

et al. 2019

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Objectives: Enhanced recovery after surgery (ERAS) protocols were first developed in colorectal surgery and sought to standardize patient care. There have been several studies in the head and neck surgical literature looking at outcomes after ERAS protocol, but no studies focusing on narcotic use and length of stay. This study aimed to evaluate narcotic usage and length of stay, in addition to several other outcomes, following the implementation of an ERAS protocol.Methods: A head and neck-specific ERAS protocol was implemented at this tertiary care center beginning July 2017. A retrospective cohort study was performed comparing this cohort to that of a retrospective control group. Outcomes included mean morphine equivalent dose, mean pain score, and percentage of patients prescribed narcotics on discharge. Secondary outcomes included ICU and total length of stay.Results: The mean morphine equivalent dose (MED) administered within 72 hours postoperatively was significantly lower in the ERAS group (17.5 AE 46.0 mg vs. 82.7 AE 116.1 mg, P < .001). Average postoperative pain scores in the first 72 hours were lower in the ERAS group (2.6 AE 1.8 vs. 3.6 AE 1.9; P < .001). The average length of stay was shorter for ERAS patients (7.8 AE 4.8 vs. 9.7 AE 4.7 days, P = .008); however, there was no significant difference in ICU length of stay.Conclusion: Following implementation of an ERAS protocol, patients undergoing head and neck surgery had decreased narcotic use in the immediate postoperative period and at discharge, while also demonstrating improved postoperative analgesia.

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“…Morbidity rates vary between surgical units and rates can be upto 70% from units reporting series of patients receiving major Head & Neck surgery with free-tissue transfer. 1 To mitigate some of the subjectivity involved in recognising a complication, and to improve consistency, the Clavien-Dindo classification system was developed 2 , which is well covered in the surgical literature and has been applied to Head and Neck surgery by multiple authors 1,3,4,5,6 it allows recording of surgical complications and systemic complications in a clear fashion that facilitates comparative audit. The authors state that 'complications are "any deviation from the ideal postoperative course that is not inherent in the procedure and does not comprise a failure to cure" and further underscore their belief that "the incidence of postoperative complications [should still be] the most frequently used surrogate marker of quality in surgery."…”

Section: Introductionmentioning

confidence: 99%

Machine learning methods applied to audit of surgical outcomes after treatment for cancer of the head and neck

Tighe¹,

Lewis-Morris²,

Freitas

2019

British Journal of Oral and Maxillofacial Surgery

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Postoperative complications after head and neck operations that require free tissue transfer - prevalent, morbid, and costly

Cited by 40 publications

References 12 publications

Complications and outcome after free flap surgery for cancer of the head and neck

Complications and outcome after free flap surgery for cancer of the head and neck

Enhanced recovery after surgery in head and neck surgery: Reduced opioid use and length of stay

Machine learning methods applied to audit of surgical outcomes after treatment for cancer of the head and neck

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