Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck

• Published in: Head & neck Vol. 32; no. 10; pp. 1345 - 1353
• Main Authors: Patel, Rajan S., McCluskey, Stuart A., Goldstein, David P., Minkovich, Leonid, Irish, Jonathan C., Brown, Dale H., Gullane, Patrick J., Lipa, Joan E., Gilbert, Ralph W.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.10.2010; Wiley
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Alcohol Drinking - adverse effects; Biological and medical sciences; Body Mass Index; Comorbidity; complication; Female; free flap; Free Tissue Flaps; head and neck cancer; Head and Neck Neoplasms - surgery; Hemoglobins - analysis; Humans; Isotonic Solutions - administration & dosage; Length of Stay - statistics & numerical data; Logistic Models; Male; Medical sciences; Middle Aged; morbidity; Mouth Mucosa - surgery; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Postoperative Complications; Prospective Studies; reconstruction; Respiratory Mucosa - surgery; Risk Factors; Severity of Illness Index; Smoking - adverse effects; Time Factors; Tracheostomy; Tumors; Weight Loss; Young Adult; Prognosis; Stomatology; ENT; Anatomical reconstruction; Malignant tumor; Morbidity; Treatment; Surgery; Risk factor; Free flap; Head and neck; ENT disease; Head and neck cancer; Complication; reconstruction; Hospital; Cancer
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.21331

Background We aimed to determine predictors of morbidity in patients undergoing microvascular free flap reconstruction of the head and neck. Methods We prospectively evaluated 796 cases between 1999 and 2007 using univariate and multivariate analysis to determine predictors of morbidity and prolonged hospital stay. Results Two hundred thirty‐nine patients (30%) developed major complications. Age, body mass index (BMI), American Society of Anesthesiology (ASA) score, Kaplan Feinstein comorbidity index (KFI) score, preoperative hemoglobin, and tracheostomy were independent predictors of major complication. Predictors of prolonged hospital stay included age, recent weight loss, alcohol excess, ASA, KFI, preoperative hemoglobin, mucosal surgery, anesthesia duration, and crystalloid replacement volume. Conclusion Several variables are associated with an increased risk of development of major complications following free flap reconstruction of the head and neck. Although many of these variables are irreversible, they aid risk stratification of patients undergoing free flap reconstruction, and assist clinicians in making treatment decisions, consenting, and providing patients with realistic expectations regarding their perioperative course. © 2010 Wiley Periodicals, Inc. Head Neck, 2010