Impact of patient comorbidities on head and neck microvascular reconstruction. A report on 423 cases.
The aim of this study was to assess the impact of the different subtypes of patient comorbidities on the outcomes of head and neck microvascular reconstruction. A total of 423 patients who underwent head and neck free flap reconstruction in our institution between 2000 and 2010 were included in this retrospective study. The impact of the different subtypes of patient comorbidities (as defined by the Kaplan-Feinstein Index) and other global health status-related factors on free flap success, local and general complications, postoperative mortality and length of stay was assessed in univariate and multivariate analysis. We found no correlation between patient comorbidities and free flap failure. In multivariate analysis, we demonstrated a significant correlation between tobacco consumption (p = 0.04) and local complications. Gastro-intestinal comorbidity (p = 0.005) and malnutrition (p = 0.02) were associated with a higher risk of fistula formation. Diabetes mellitus (p = 0.003), gastro-intestinal (p = 0.02), systemic (p = 0.02) and cardiac comorbidities (p = 0.03) were significant predictors of medical complications. We concluded that the different subtypes of patient comorbidities were relevant predictors of complications in head and neck microvascular reconstruction.
Department of Surgery, Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103 Nice, France.
Clair
C
Vandersteen
Olivier
O
Dassonville
Emmanuel
E
Chamorey
Gilles
G
Poissonnet
Eric Edi Martial
EE
Nao
Cédric Sandy
CS
Pierre
Axel
A
Leyssale
Frédéric
F
Peyrade
Marie Noelle
MN
Falewee
Anne
A
Sudaka
Juliette
J
Haudebourg
François
F
Demard
José
J
Santini
Alexandre
A
Bozec
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005402:Fistula; D058752:Free Tissue Flaps / Q000098:blood supply*; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000601:surgery; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D055815:Young Adult