APACHE II scoring for the prediction of immediate surgical complications in head and neck cancer patients.
BACKGROUND
Aggressive surgical treatment of oral and oropharyngeal cancers may be compromised by significant surgical complications. Early identification of patients at risk for postoperative complications may assist in clinical decision-making. The objective of this study was to assess the value of the Acute Physiology and Chronic Health Evaluation (APACHE II) score in predicting early postoperative surgical complications.


METHODS
There were 510 cases of free tissue transfer surgery identified on the Liverpool Oncology Head and Neck Database for 1995 to 2002. APACHE II data were collected independently from critical care records and by case note retrieval. The authors' main a priori outcomes were total flap failure and any immediate complication requiring further surgery (including any from hemorrhage, hematoma, partial flap failure, airways, and anastomosis exploration).


RESULTS
Overall total flap loss and immediate complication rates were 6.2 percent (30 of 485) and 13.6 percent (66 of 485), respectively. APACHE II data were known for 399 operations (82 percent) and, of these, 90 percent (360 of 399) were managed postoperatively in the critical care unit. There were clear correlations between APACHE II scores with total flap loss and with other immediate complications.


CONCLUSIONS
The APACHE II score is associated with immediate postoperative surgical complications involving flap compromise and thus may be a useful tool in postoperative decision-making.
Grant
Chris A
CA
Liverpool, United Kingdom From the Critical Care Department and the Department of Maxillofacial Surgery, University Hospital Aintree.
Dempsey
Ged A
GA
Lowe
Derek
D
Brown
James S
JS
Vaughan
E David
ED
Rogers
Simon N
SN
D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome