Factors Influencing the Incidence of Severe Complications in Head and Neck Free Flap Reconstructions.
BACKGROUND
Complications after head and neck free-flap reconstructions are detrimental and prolong hospital stay. In an effort to identify related variables in a tertiary regional head and neck unit, the microvascular reconstruction activity over the last 5 years was captured in a database along with patient-, provider-, and volume-outcome-related parameters.


METHODS
Retrospective cohort study (level of evidence 3), a modified Clavien-Dindo classification, was used to assess severe complications.


RESULTS
A database of 217 patients was created with consecutively reconstructed patients from 2009 to 2014. In the univariate analysis of severe complications, we found significant associations (P< 0.05) between type of flap used, American Society of Anesthesiologists classification, T-stage, microscope use, surgeon, flap frequency, and surgeon volume. Within a binomial logistic regression model, less frequently versus frequently performed flap (odds ratio [OR] = 3.2; confidence interval [CI] = 2.9-3.5;P= 0.000), high-volume versus low-volume surgeon (OR = 0.52; CI = -0.22 to 0.82;P= 0.007), and ASA classification (OR = 2.9; CI = 2.4-3.4;P= 0.033) were retained as independent predictors of severe complications. In a Cox-regression model, surgeon (P= 0.011), site of reconstruction (P= 0.000), T-stage (P= 0.001), and presence of severe complications (P= 0.015) correlated with a prolonged hospitalization.


CONCLUSIONS
In this study, we identified a correlation of patient-related factors with severe complications (ASA score) and prolonged hospital stay (T-stage, site). More importantly, we identified several provider- (surgeon) and volume-related (frequency with which a flap was performed and high-volume surgeon) factors as predictors of severe complications. Our data indicate that provider- and volume-related parameters play an important role in the outcome of microvascular free-flap procedures in the head and neck region.
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Martin
M
Broome
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Naline
N
Juilland
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Yann
Y
Litzistorf
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Yan
Y
Monnier
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Kishore
K
Sandu
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Philippe
P
Pasche
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Peter K
PK
Plinkert
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Philippe A
PA
Federspil
Division of Maxillo-Facial Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; Department of Otolaryngology-Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland; and Department of Otolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
Christian
C
Simon