Analysis of Operative Mortality and Post-operative Lethal Complications after Head and Neck Reconstruction with Free Tissue Transfer

Tanaka, Kentaro; Sakuraba, Minoru; Miyamoto, Shinpei; Hayashi, Ryuichi; Ebihara, Mitsuru; Miyazaki, Masakazu; Shinozaki, Takahiro; Daiko, Hiroyuki; Yano, Tomoyuki

doi:10.1093/jjco/hyr046

Cited by 16 publications

(22 citation statements)

References 14 publications

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“…The 30-day mortality rates in our study were higher than those reported in the developed countries. Tanaka et al 8 reported mortality rates of 0.88 per 100 surgeries in Japan, and Pohlenz et al 9 reported intrahospital mortality of 1.0 per 100 surgeries in Germany. Our study found the 30-day mortality rate to range from 3.14 in Bogota to 4.29 in the Pacific region, per 100 surgeries.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study

Buitrago

Caballero

Montealegre

2020

Plastic and Reconstructive Surgery - Global Open

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Background: The purpose of this study was to determine the perioperative mortality rate, reintervention rate, and total healthcare costs for head and neck cancer patients who underwent free tissue transfer (FTT) in Colombia. The prognostic factors associated with those results were estimated. Methods: A retrospective cohort study was performed using administrative data from patients of all ages diagnosed with head and neck cancer who underwent FTT between 2013 and 2016 in Colombia’s contributory health system. Postoperative mortality rates were estimated at 30, 90, and 180 days, as well as reintervention rates at 30 and 90 days. Total healthcare costs were calculated. Generalized linear models were generated to determine prognostic factors associated with outcomes. Results: A total of 485 patients were included, 215 (44.33%) of which were women. Mean age was 61.4 years. Mortality rate was 3.09 at 30 days, 9.28 at 90 days, and 15.26 at 180 days, per 100 surgeries. Reintervention rate was 5.77 at 30 days and 8.25 at 90 days, per 100 surgeries. The 30-day reintervention rate was lower for 40- to 59-year-old group and for a Charlson Index ≤ 3. The median total healthcare cost of an episode was USD 12,403.68 (interquartile range, 5754–16,736). The bivariate and multivariate models determined that age, the Charlson Index, and geographic region were associated with outcomes. Conclusion: For patients undergoing FTT in Colombia, differences in reintervention and total costs incurred by the national health system exist, and these differences are associated with age, the Charlson Index, and the geographic region.

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Section: Discussionmentioning

confidence: 99%

Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study

Buitrago

Caballero

Montealegre

2020

Plastic and Reconstructive Surgery - Global Open

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“…11,19 Knowledge of the cause of death after microvascular reconstruction in patients with HNC has been limited. Tanaka et al 26 analyzed the data from patients with HNC who had been treated with free flaps. They found a short-term (30-day) mortality of 0.88%; however, the long-term survival was not analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…They found a short-term (30-day) mortality of 0.88%; however, the long-term survival was not analyzed. 26 Lahtinen et al 27 retrospectively analyzed the survival and cause of death in 146 patients with head and neck free flap reconstruction at a median follow-up of 3 years. HNC was the primary cause of death in most (73%) patients, 27 in line with the results from the present study (79%).…”

Section: Discussionmentioning

confidence: 99%

Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery

Kainulainen

Aro

Koivusalo

et al. 2020

Journal of Oral and Maxillofacial Surgery

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Purpose: Studies of the effects of perioperative dexamethasone (DEX) during oncologic surgery are scarce. The first aim of the present study was to clarify whether perioperative DEX affects the shortterm mortality in patients with head and neck cancer (HNC). The second aim was to analyze the causes of death and predictors affecting long-term mortality. Patients and Methods: The present prospective, double-blind randomized, controlled study included patients with HNC who had undergone microvascular reconstruction from 2008 through 2013. The patients were randomized into 2 groups: the receipt of perioperative DEX for 3 days (study group) or no DEX (control group). The patients' data and cause of death were registered until the end of 2017. The primary cause of death was used in the analyses. Results: A total of 93 patients were included in the present study: 51 in the DEX group (study group) and 42 in the NON-DEX group (control group). Altogether 38 patients died during a median follow-up period of 5.3 years. During the first year, more deaths had occurred in the DEX group than in the NON-DEX group: at 1 month, 4% versus 0%; at 6 months, 14% versus 0%; and at 12 months, 22% versus 5% (P = .043). The overall survival rate for all patients was 59%. HNC was the primary cause of death for most of the patients who died. On univariate analysis, the deceased patients had more advanced disease (higher T classification, P = .002; higher stage, P = .008), a greater need for a gastrostoma (P = .002), more often received postoperative chemotherapy (P = .005), and more often had locoregional (P = .025) or distal (P < .001) metastases. In the multivariate Cox model, the most important long-term predictors of death were the presence of

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“…In the present study, the operative duration in the VBG group was significantly longer than those of the other two groups, and the volume of intraoperative blood loss tended to be greater than that of the MRP group. These differences may have little impact on young, healthy patients but can be critical in elderly patients and increase the risk of operative mortality . The indication of VBG for elderly patients should therefore be carefully evaluated by weighing its merits against various factors such as age, comorbidities, tumor status, and availability of donor sites.…”

Section: Discussionmentioning

confidence: 99%

Mandibular reconstruction in elderly patients

Miyamoto

Higashino

Sakuraba

2018

Journal of Surgical Oncology

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Analysis of Operative Mortality and Post-operative Lethal Complications after Head and Neck Reconstruction with Free Tissue Transfer

Cited by 16 publications

References 14 publications

Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study

Reconstruction with Free Flaps of Head and Neck Cancer Defects: A National Cohort Study

Perioperative Dexamethasone Is Associated With Higher Short-Term Mortality in Reconstructive Head and Neck Cancer Surgery

Mandibular reconstruction in elderly patients

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