Predictors of morbidity following free flap reconstruction for cancer of the head and neck

• Published in: Head & neck Vol. 29; no. 12; pp. 1090 - 1101
• Main Authors: Clark, Jonathan R., McCluskey, Stuart A., Hall, Francis, Lipa, Joan, Neligan, Peter, Brown, Dale, Irish, Jonathan, Gullane, Patrick, Gilbert, Ralph
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.2007; John Wiley & Sons
• Subjects: Age Factors; ASA; Biological and medical sciences; Blood Volume; Charlson comorbidity index; Colloids; complications; Female; head and neck cancer; Head and Neck Neoplasms - surgery; Hemoglobins - analysis; Humans; Kaplan-Feinstein index; Length of Stay; Male; Medical sciences; Middle Aged; Neoadjuvant Therapy; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Outcome Assessment (Health Care); Parotid Gland - surgery; Perioperative Care; Postoperative Complications; Retrospective Studies; Smoking - adverse effects; Surgical Flaps; Tracheostomy; Tumors; complications; Stomatology; Prediction; Kaplan-Feinstein index; ENT; Anatomical reconstruction; Malignant tumor; Epidemiology; Morbidity; Charlson comorbidity index; ASA; Concomitant disease; Treatment; Surgery; Free flap; Head and neck; ENT disease; Head and neck cancer; Complication; Predictive factor; Cancer
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.20639

Background Free flap reconstruction of head and neck cancer defects is complex with many factors that influence perioperative complications. The aim was to determine if there was an association between perioperative variables and postoperative outcome. Methods We evaluated 185 patients undergoing free flap reconstruction following ablation of head and neck cancer between 1999 and 2001. Demographic, laboratory, surgical and anesthetic variables were analyzed using univariate and multivariable techniques. Results Ninety‐eight patients (53%) developed complications, of which 74 were considered major, giving a major morbidity rate of 40%. Predictors of major complications were increasing patient age, ASA class, and smoking. Predictors of medical complications were ASA class, smoking, age and crystalloid replacement. Predictors of surgical complications were tracheostomy, preoperative hemoglobin, and preoperative radiotherapy. Conclusion Patient age, comorbidity, smoking, preoperative hemoglobin, and perioperative fluid management are potential predictors of postoperative complications following free flap reconstruction for cancer of the head and neck. © 2007 Wiley Periodicals, Inc. Head Neck 2007