Factors Influencing the Incidence of Severe Complications in Head and Neck Free Flap Reconstructions

Abstract

Background:Complications after head and neck free-flap reconstructions are detrimental and prolong hospital stay. In an effort to identify related variables in a tertiary regional head and neck unit, the microvascular reconstruction activity over the last 5 years was captured in a database along with patient-, provider-, and volume-outcome–related parameters.Methods:Retrospective cohort study (level of evidence 3), a modified Clavien-Dindo classification, was used to assess severe complications.Results:A database of 217 patients was created with consecutively reconstructed patients from 2009 to 2014. In the univariate analysis of severe complications, we found significant associations (P < 0.05) between type of flap used, American Society of Anesthesiologists classification, T-stage, microscope use, surgeon, flap frequency, and surgeon volume. Within a binomial logistic regression model, less frequently versus frequently performed flap (odds ratio [OR] = 3.2; confidence interval [CI] = 2.9–3.5; P = 0.000), high-volume versus low-volume surgeon (OR = 0.52; CI = −0.22 to 0.82; P = 0.007), and ASA classification (OR = 2.9; CI = 2.4–3.4; P = 0.033) were retained as independent predictors of severe complications. In a Cox-regression model, surgeon (P = 0.011), site of reconstruction (P = 0.000), T-stage (P = 0.001), and presence of severe complications (P = 0.015) correlated with a prolonged hospitalization.Conclusions:In this study, we identified a correlation of patient-related factors with severe complications (ASA score) and prolonged hospital stay (T-stage, site). More importantly, we identified several provider- (surgeon) and volume-related (frequency with which a flap was performed and high-volume surgeon) factors as predictors of severe complications. Our data indicate that provider- and volume-related parameters play an important role in the outcome of microvascular free-flap procedures in the head and neck region.

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

“…This might be explained by differences in how the complications were recorded. 2,8,9,11 We did not categorize the complications as severe versus non-severe. Instead, we were interested in the timing of complication onset and aimed to record each complication that might possibly affect patient postoperative course and recovery.…”

“…There is also continued debate about the use of grading systems that are commonly used for postoperative complications in other fields of surgery. 1,2,5,8,9 In the present study, we used a simple classification for medical and surgical complications that could be reliably used in our retrospective review of medical records. The present study was performed in a low volume center, with median annual operation rate of 16.…”

“…Moreover, the impact of postoperative complications on recovery, hospital length of stay (LOS), oncological treatment plan and outcome remains unclear. 1,5,[8][9][10] Because the rate of postoperative complications in this patient group is relatively high, patient selection, prognosis and the true cost of microvascular surgery continue to be discussed. 1,7 Accordingly, we aimed to evaluate the onset and distribution of surgical complications and their impact on postoperative recovery and outcome in a cohort of patients who underwent major head and neck surgery with free flap repair.…”

Qualität in der Kopf-Hals-Onkologie

“…Lin et al [59] konnten in einer taiwanesischen Kohorte erstmals einen Zusammenhang zwischen chirurgischem Behandlungsvolumen und 5-Jahres-Überlebensrate für orale Karzinome zeigen. Der Zusammenhang zwischen Chirurgenvolumen und Outcome bei Kopf-Hals-Karzinomen wurde in weiteren Studien bestätigt [47,48,60]. Der Bedeutung des Chirurgenvolumens für die Prognose wird im Rahmen der DKG-Zertifizierung dadurch Rechnung getragen, dass die Kopf-Hals-Tumorchirurgen und Nachwuchsoperateure im Erhebungsbogen namentlich festgelegt werden müssen, und Kopf-Hals-Tumor-Operateure mindestens 30 onkologische Operationen (Primärfälle/ Rezidive) in 5 Jahren und dann zur Aufrechterhaltung der Qualifikation mindestens 10 Operationen pro Jahr (Primärfälle/ Rezidive) durchführen müssen.…”

American Society of Anesthesiologists Class as Predictor for Perioperative Morbidity in Head and Neck Free Flaps

“…The goal of reconstruction in head and neck surgery is to restore not only form but also function, and free tissue transfer (FTT) can often provide for better functional and aesthetic outcomes. 1,2 The ideal reconstruction substrate provides maximum functionality while minimizing morbidity. 3 With a success rate greater than 90% to 95%, 1,4-13 microvascular FTT is a consistent and effective alternative and, in many cases, considered the gold standard for reconstruction of certain head and neck defects.…”