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

Abstract

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.

Risk Factors of Free Flap Complications in Reconstruction for Head and Neck Cancer

“…Consequently, the length of hospital stay may be prolonged, potentially increasing the medical cost. 6,7 Various reports have analyzed the risk factors of FC in head and neck reconstruction surgery. However, patient-dependent risk factors of FC such as comorbidity, life style and habit, general condition, and history of therapy are often difficult to eliminate at the time of head and neck reconstruction surgery.…”