title: An analysis of early oncologic head and neck free flap reoperations from the 2005-2012 ACS-NSQIP dataset.
abstract: BACKGROUND
  There are limited population-based studies that examine perioperative factors that influence postoperative surgical take-backs to the OR following free flap (FF) reconstruction for head/neck cancer extirpation. The purpose of this study was to critically analyse head/neck free flaps (HNFF) captured in the ACS-NSQIP dataset with a specific focus on postoperative complications and the incidence of factors associated with re-operation.
  
  
  METHODS
  The 2005-2012 ACS-NSQIP datasets were accessed to identify patients undergoing FF reconstruction after a diagnosis of head/neck cancer. Patient demographics, comorbidities, and perioperative risk factors were examined as covariates, and the primary outcome was return to OR within 30 days of surgery. A multivariate regression was performed to determine independent preoperative factors associated with this complication.
  
  
  RESULTS
  In total, 855 patients underwent FF for head/neck reconstruction most commonly for the Tongue (24.7%) and Mouth/Floor/cavity (25.0%). Of these, 153 patients (17.9%) returned to the OR within 30 days of surgery. Patients in this cohort had higher rates of wound infections and dehiscence (p < 0.01). Medical complications were significantly higher and included pneumonia (12.4% vs 5.0%, p < 0.01), prolonged ventilation (16.3% vs 4.8%, p < 0.01), myocardial infarction (2.6% vs 0.6%, p = 0.017), and sepsis (7.2% vs 3.4%, p = 0.033). Regression analysis demonstrated that visceral flaps (OR = 9.7, p = 0.012) and hypoalbuminemia (OR = 2.4, p = 0.009) were significant predictors of a return to the OR.
  
  
  CONCLUSIONS
  Based on data from the nationwide NSQIP dataset, up to 17% of HNFF return to the OR within 30 days. Although this data-set has some significant limitations, these results can cautiously help to improve preoperative patient optimisation and surgical decision-making.
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Cassandra A
authors.initials: CA
authors.lastname: Ligh
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Gerety
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
authors.affiliation: a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Suhail K
authors.initials: SK
authors.lastname: Kanchwala
mesh_terms: D066264:Datasets as Topic; D058752:Free Tissue Flaps / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012044:Regression Analysis; D012086:Reoperation; D016896:Treatment Outcome
keywords: Flaps; microvascular; tumour