title: Delayed mobilization after microsurgical reconstruction: an independent risk factor for pneumonia.
abstract: OBJECTIVE
  Large defects secondary to oral cancer resection are reconstructed with microsurgical free flaps. Pulmonary complications in these patients are common. Postoperative mobilization is recommended to decrease respiratory complications; however, many microsurgeons are reluctant to adopt early mobilization protocols due to the perceived risk of flap compromise. The purpose of this study was to determine the incidence of pneumonia among patients undergoing oral cancer resection and immediate free flap reconstruction and to compare the incidence of this complication between patients mobilized early (<4 days postoperative) versus later. A secondary goal was to determine whether early postoperative mobilization affected microvascular flap outcome.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Sixty-two consecutive patients treated between 2005 and 2009 with oral carcinoma resection and free flap reconstruction were studied. Information pertaining to comorbidities, postoperative care, and complications were collected. Risk factors for development of pulmonary and flap complications were analyzed.
  
  
  RESULTS
  The incidence of pneumonia was 30.6%. Longer intensive care unit stay (P = 0.01), tracheostomy decannulation later than 10 days (P = 0.04), and longer operative times (P = 0.04) were significantly associated with pneumonia. Delayed mobilization (after day 4 postoperative) was an independent risk factor for pneumonia (OR = 4.2, 95% CI: 1.1, 17.1). Early mobilization (before day 4 postoperative) was not associated with an increased incidence of secondary flap procedures or flap failure.
  
  
  CONCLUSIONS
  Late mobilization of free flap patients is an independent risk factor for developing postoperative pneumonia. Earlier mobilization does not increase flap failure rates, is safe, and should be strongly considered in all free flap patients to reduce pulmonary complications.
authors.affiliation: Division of Plastic & Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Yeung
authors.forename: Robertson
authors.initials: R
authors.lastname: Harrop
authors.forename: Olivia
authors.initials: O
authors.lastname: McCreary
authors.forename: Leslie T
authors.initials: LT
authors.lastname: Leung
authors.forename: Naushad
authors.initials: N
authors.lastname: Hirani
authors.forename: David
authors.initials: D
authors.lastname: McKenzie
authors.forename: Vim
authors.initials: V
authors.lastname: de Haas
authors.forename: T Wayne
authors.initials: TW
authors.lastname: Matthews
authors.forename: Steve
authors.initials: S
authors.lastname: Nakoneshny
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
authors.forename: Christiaan
authors.initials: C
authors.lastname: Schrag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Microsurgery; mobilization; pneumonia