title: Are females predisposed to complications in head and neck cancer free flap reconstruction?
abstract: OBJECTIVE
  To investigate gender and other possible factors affecting the frequency and severity of postoperative complications in head and neck cancer free flap reconstruction.
  
  
  METHODS
  A prospective longitudinal cohort study was conducted at the Greek Anticancer Institute, St. Savvas Hospital in head and neck cancer free flap reconstruction concerning postoperative complications. We documented the patients' demographic characteristics, social habits, and perioperative factors (ie, duration of general anesthesia), reconstructive techniques, neoadjuvant radiotherapy, and physical status. Initially, univariate statistical analysis was performed to confirm which predictor variables might influence the presence and severity of complications. Next, multivariate statistical analysis was performed using logistical regression and including the factors that were statistically significant on univariate analysis.
  
  
  RESULTS
  From 1999 to 2009, we assessed 95 patients who had undergone surgery for head and neck cancer. Of the 95 patients, 24 were women and 71 were men. The patient age range was 20 to 87 years (mean 52, median 55). A total of 55 complications occurred in 49 patients (51.57%). Of the 55 complications, 12 (12.63%) were of major severity, 21 (22.10%) of median severity, and 22 (23.15%) of low severity. The statistical analysis revealed that the factors associated with complications were preoperative radiotherapy, female gender, and operation time. The factors associated with severe complications were female gender and alcohol use.
  
  
  CONCLUSIONS
  Multivariate analysis of the data revealed that the factor associated with an increased incidence of postoperative complications was preoperative radiotherapy. Moreover, the variable that remained statistically significant and correlated with an increased incidence and severity of free flap reconstruction complications was female gender. Identifying the etiology of these findings is an intriguing field for additional research.
authors.affiliation: Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, "Agia Sofia" Children's Hospital, Athens, Greece. Electronic address: aloupatatzi@hotmail.com.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Loupatatzi
authors.affiliation: Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, Greek Anticancer Institute, St. Savvas Hospital, Athens, Greece.
authors.forename: Spyridon Dimitrios
authors.initials: SD
authors.lastname: Stavrianos
authors.affiliation: Resident, Department of Plastic and Reconstructive Surgery, Athens Naval Hospital, Athens, Greece.
authors.forename: Fotios Filippos
authors.initials: FF
authors.lastname: Karantonis
authors.affiliation: Professor, Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Athens, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Machairas
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Greek Anticancer Institute, St. Savvas Hospital, Athens, Greece.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Rapidis
authors.affiliation: Department of Plastic and Reconstructive Surgery, Greek Anticancer Institute, St. Savvas Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Kokkalis
authors.affiliation: Professor, Department of Plastic and Reconstructive Surgery, National and Kapodistrian University of Athens, Athens Medical School, Athens, Greece.
authors.forename: Othon
authors.initials: O
authors.lastname: Papadopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D000768:Anesthesia, General / Q000145:classification; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D015331:Cohort Studies; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000145:classification / Q000637:transplantation*; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D061646:Operative Time; D011183:Postoperative Complications / Q000145:classification; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D055815:Young Adult