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


CONCLUSIONS
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.
Patel
Rajan S
RS
Department of Otolaryngology-Head and Neck Surgery/Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
McCluskey
Stuart A
SA
Goldstein
David P
DP
Minkovich
Leonid
L
Irish
Jonathan C
JC
Brown
Dale H
DH
Gullane
Patrick J
PJ
Lipa
Joan E
JE
Gilbert
Ralph W
RW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D015992:Body Mass Index; D015897:Comorbidity; D000077324:Crystalloid Solutions; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D020545:Respiratory Mucosa / Q000601:surgery; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D014139:Tracheostomy; D015431:Weight Loss; D055815:Young Adult
D000077324:Crystalloid Solutions; D006454:Hemoglobins; D007552:Isotonic Solutions