title: Characteristics and intraoperative treatments associated with head and neck free tissue transfer complications and failures.
abstract: OBJECTIVE
  To investigate the association between perioperative patient characteristics and treatment modalities (eg, vasopressor use and volume of fluid administration) with complications and failure rates in patients undergoing head and neck free tissue transfer (FTT).
  
  
  METHODS
  A retrospective review of medical records.
  
  
  METHODS
  Perioperative hospitalization for head and neck FTT at 1 tertiary care medical center between January 1, 2009, and October 31, 2011.
  
  
  METHODS
  Consecutive patients (N=235) who underwent head and neck FTT. Demographic, patient characteristic, and intraoperative data were extracted from medical records. Complication and failure rates within the first 30 days were collected
  
  
  RESULTS
  In a multivariate analysis controlling for age, sex, ethnicity, reason for receiving flap, and type and volume of fluid given, perioperative complication was significantly associated with surgical blood loss (P=.019; 95% confidence interval [CI], 1.01-1.16), while the rate of intraoperative fluid administration did not reach statistical significance (P=.06; 95% CI, 0.99-1.28). In a univariate analysis, FTT failure was significantly associated with reason for surgery (odds ratio, 5.40; P=.03; 95% CI, 1.69-17.3) and preoperative diagnosis of coronary artery disease (odds ratio, 3.60; P=.03; 95% CI, 1.16-11.2). Intraoperative vasopressor administration was not associated with either FTT complication or failure rate.
  
  
  CONCLUSIONS
  FTT complications were associated with surgical blood loss but not the use of vasoactive drugs. For patients undergoing FTT, judicious monitoring of blood loss may help stratify the risk of complication and failure.
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA handw@musc.edu.
authors.forename: William R
authors.initials: WR
authors.lastname: Hand
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Julie R
authors.initials: JR
authors.lastname: McSwain
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McEvoy
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Bethany
authors.initials: B
authors.lastname: Wolf
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Abdalrahman A
authors.initials: AA
authors.lastname: Algendy
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Parks
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Murray
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Reeves
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013022:South Carolina / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: anesthesia management; head and neck free tissue transfer; intraoperative blood loss; intraoperative fluid management; intraoperative vasopressors