title: Postoperative complications after major head and neck surgery with free flap repair--prevalence, patterns, and determinants: a prospective cohort study.
abstract: This study aims to give a better understanding of the prevalence, patterns, and determinants of postoperative complications, to evaluate the Clavien-Dindo classification of surgical complications, and to set out a protocol to improve postoperative recovery. Over a period of 27 months we studied 192 patients who had had major head and neck operations with free flaps. Data on complications were gathered prospectively along with patients' details, comorbidities, factors indicative of the magnitude of the surgical insult, and variations in perioperative care. Complications were classified according to the Clavien-Dindo system. Outcomes analysed comprised any complication, major complications (Clavien-Dindo III and above), wound complications, and pulmonary complications. A total of 64% of patients had complications, and in around one third they were serious; wound and pulmonary complications were the most common. Factors significantly associated with complications reflected an interaction between coexisting conditions of the patient at operation and the magnitude of the surgery. Perioperative interventions to ensure preoperative optimisation of patients, and to lessen the systemic inflammatory response that results from operation offer the best prospect of reducing the burden of surgical complications. A protocol to improve recovery after operation would be appropriate. The Clavien-Dindo classification of surgical complications is useful in this group.
authors.affiliation: Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: jeremymcmahon@nhs.net.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: McMahon
authors.forename: Colin
authors.initials: C
authors.lastname: MacIver
authors.forename: Miller
authors.initials: M
authors.lastname: Smith
authors.forename: Panos
authors.initials: P
authors.lastname: Stathopoulos
authors.forename: Craig
authors.initials: C
authors.lastname: Wales
authors.forename: Richard
authors.initials: R
authors.lastname: McNulty
authors.forename: Thomas P B
authors.initials: TP
authors.lastname: Handley
authors.forename: John C
authors.initials: JC
authors.lastname: Devine
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D019990:Perioperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology*; D011446:Prospective Studies; D020127:Recovery of Function; D012606:Scotland / Q000453:epidemiology; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D012737:Sex Factors; D014652:Vascular Diseases / Q000453:epidemiology; D055815:Young Adult
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein
keywords: Clavien–Dindo classification; Free flap; Head and neck surgery; Microsurgery; Surgical complications