title: Postoperative alcohol withdrawal syndrome and neuropsychological disorder in patients after head and neck cancer ablation followed by microsurgical free tissue transfer.
abstract: OBJECTIVE
  The use of microsurgical free flap reconstruction has resulted in improved patient outcomes and survival after head and neck cancer resection. Although postoperative care in an intensive care unit (ICU) for airway management and flap surveillance can increase the success rate, any accompanying neuropsychological problems can potentially affect the outcome.
  
  
  METHODS
  From January 2006 to December 2008, we retrospectively reviewed 1,506 ICU patients who underwent head and neck cancer ablative surgery followed by microsurgical free tissue transfer. Twelve patients (Group A) had alcohol withdrawal syndrome (AWS), whereas 29 patients (Group B) had other neuropsychological problems. The clinical manifestations and outcomes of each group were investigated and statically analyzed.
  
  
  RESULTS
  All the flaps survived. There was no significant difference in onset time, duration, ICU stay, hospital stay interval, overall complications, and flap circulation-related complications. However, the non-flap-related complication rates (10/12, 83.3%; 14/29, 48.3%; p = 0.038), including failure of extubation or ventilator weaning (7/12, 58.3%; 7/29, 24.1%; p = 0.036), were significantly higher in Group A.
  
  
  CONCLUSIONS
  Patients with postoperative AWS have a higher chance of developing non-flap-related complications, especially respiratory problems. The identification of a multidisciplinary approach to identify and manage these patients preoperatively and postoperatively is required.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Chia-yi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chang-Cheng
authors.initials: CC
authors.lastname: Chang
authors.forename: Huang-Kai
authors.initials: HK
authors.lastname: Kao
authors.forename: Jung-Ju
authors.initials: JJ
authors.lastname: Huang
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
mesh_terms: D000328:Adult; D060666:Airway Extubation; D000437:Alcoholism / Q000150:complications*; D003422:Critical Care; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation; D016896:Treatment Outcome; D015300:Ventilator Weaning