Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures

Abstract

Objective To (1) determine the overall complication rate, wound healing, and wound infection complications and (2) identify preoperative, intraoperative, and postoperative predictors of these complications. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (2006-2012) were assessed. Multivariable logistic regression assessed the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results Of the 515 patients identified, 54% had a complication predicted by longer operating room (OR) time, higher comorbidity index, and oral cavity and pharyngeal tumor sites. Predictors of wound-healing complications (15%) were longer OR time, volume of crystalloid given intraoperatively, and oral cavity and pharyngeal tumor sites. Predictors of wound infection (12%) were younger age, diabetes mellitus, and malnutrition. Conclusions Wound healing and infectious complications account for most complications in patients with head and neck cancer undergoing free flap reconstruction. Clean contaminated wounds are a significant predictor of wound complications. Advanced OR time, advanced age, and comorbidity status, including diabetes mellitus and malnutrition, are other important predictors. Crystalloid administration is also an important predictor of wound-healing complications, and this warrants further study.

Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction

“…Previously, our group has reported 2 studies using this database and cohort describing (1) the general predictors of complications in head and neck free flap patients and (2) predictors of hospital quality metrics. 16,17 The development of any medical or surgical complication was the most important predictor of increased hospital length of stay, readmission, or unplanned return to the operating room. Wound healing and infectious complications were the most common complication in the cohort and were predicted by longer operative time, advanced age, and comorbidities.…”

“…Demographic and Clinical Characteristics of 515 Patients16,17 Regional nodal disease conferred an increased risk with 16 of 107 patients with N1 and N2a disease (15.0%) and 20 of 108 with N2b and N3 disease (18.5%) developing POD compared with 20 of 300 with N0 status (6.7%), independently of operative time. Tobacco use was associated with Examination of comorbidities by organ system revealed the presence of cardiac and pulmonary disease to be significant risk factors.…”

The Use of Vasopressor Agents in Free Tissue Transfer for Head and Neck Reconstruction: Current Trends and Review of the Literature

“…Hand et al observed that patients suffering perioperative complications received on average 525 mL more crystalloid than patients without complications ( Hand et al, 2015 ). Similarly, Eskander et al noted a 1.21 fold increased risk of wound-healing complications with each additional liter of crystalloid administered intraoperatively ( Eskander et al, 2018 ). On the contrary, under-resuscitation can also result in increased free flap complications due to poor flap perfusion, worsened by further hypotension secondary to anesthetic agents ( Sigurdsson, 1995 ).…”

The Role of Free Tissue Transfer in the Management of Chronic Frontal Sinus Osteomyelitis

“…Two patients developed postoperative brow ptosis due to poor medial frontalis muscle function and atrophic forehead scars; both cases were successfully treated with brow lift. The rate of similar complications reported in the literature is variable, but ranges from 0%to 38% . Many of these studies were limited by follow‐up and did not consider cosmetic issues, such as brow ptosis, as a flap‐related complication.…”