title: Multivariate analysis as an advantageous approach for prediction of the adverse outcome in head and neck microvascular reconstructive surgery.
abstract: BACKGROUND
  The use of a free flap has become a mainstay of reconstruction following the ablative surgery in head and neck. The success rates are about 90%, however, several factors have been described to have an adverse effect on free flap survival.
  
  
  METHODS
  We have performed a retrospective analysis of the treatment outcome of 93 microvascular flaps and evaluated the factors influencing the risk of flap loss including patients' age, body mass index, smoking, general medical history and previous oncological treatment.
  
  
  RESULTS
  Out of 93 flaps the total necrosis have been observed in 15 flaps with gradual improvement in the consecutive years. In individual analysis the patients age, BMI, and comorbidities did not reveal any significant relation. The history of any previous oncological treatment represented a significant adverse factor of success rate (p=0.035), and was even more significant when patients experienced all treatment modalities prior to the reconstructive procedure (p=0.009). Multivariate logistic regression model indicated that only surgery (p=0.0008), chemotherapy (p=0.02), cardiovascular diseases (p=0.05) and patient's age (p=0.02) represented significant factors impairing the success rate.
  
  
  CONCLUSIONS
  Incorporating multivariate analysis represents important statistical approach for better prediction of free flaps survival in head and neck reconstructive surgery. Incorporation of additional collective information could provide more precise approach in the risk of the flap loss assessment.
authors.affiliation: Department of Biology and Environmental Studies, Poznan University of Medical Sciences, Poznan, Poland; Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland; University of Central Florida, Burnett School of Biomedical Sciences, College of Medicine Orlando, FL, USA. Electronic address: pawel.golusinski@wco.pl.
authors.forename: Pawel
authors.initials: P
authors.lastname: Golusinski
authors.affiliation: Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Pazdrowski
authors.affiliation: Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Szewczyk
authors.affiliation: Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pieńkowski
authors.affiliation: Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Majchrzak
authors.affiliation: University of Central Florida, Burnett School of Biomedical Sciences, College of Medicine Orlando, FL, USA; Department of Nutrition, Federal University of Pelotas, Pelotas, RS, Brazil.
authors.forename: Augusto
authors.initials: A
authors.lastname: Schneider
authors.affiliation: University of Central Florida, Burnett School of Biomedical Sciences, College of Medicine Orlando, FL, USA.
authors.forename: Michal M
authors.initials: MM
authors.lastname: Masternak
authors.affiliation: Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Golusinski
mesh_terms: D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Complications; Flap failure; Free flaps; Head and neck cancer; Microvascular surgery; Reconstruction