Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer

Objective Naso- or orbitocutaneous fistula (NOF) is a challenging complication of orbital exenteration, and it often requires surgical repair. We sought to identify the incidence and risk factors for NOF after orbital exenteration. Study Design Retrospective chart review, systematic review, meta-analysis. Setting Tertiary care center. Participants Patients undergoing free flap reconstruction following orbital exenteration. Records were reviewed for clinicopathologic data, operative details, and outcomes. Main Outcome Measures Univariate analysis was used to assess risk factors for incidence of postoperative NOF. PubMed and Cochrane databases were searched for published reports on NOF after orbital exenteration. Rates of fistula and odds ratios for predictive factors were compared in a meta-analysis. Results Total 7 of 77 patients (9.1%) developed NOF; fistula formation was associated with ethmoid sinus involvement (p < 0.05) and minor wound break down (p < 0.05). On meta-analysis, pooled rates of fistula formation were 5.8% for free flap patients and 12.5% for patients receiving no reconstruction. Conclusion Immediate postoperative wound complications and medial orbital wall resection increased the risk for NOF. On review and meta-analysis, reconstruction of orbital exenteration defects decreased the risk for fistula formation, but published series did not demonstrate a significant decrease in risk with free flaps compared with other methods of reconstruction.

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Factors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer

British Journal of Plastic Surgery ◽

10.1016/j.bjps.2004.04.006 ◽

2004 ◽

Vol 57 (6) ◽

pp. 556-560 ◽

Cited By ~ 36

Author(s):

D.J Cloke ◽

J.E Green ◽

A.L Khan ◽

P.D Hodgkinson ◽

N.R McLean

Keyword(s):

Oral Cancer ◽

Wound Infection ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Factors Influencing

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Impact of Preoperative Risk Factors on Inpatient Stay and Facility Discharge After Free Flap Reconstruction

Otolaryngology ◽

10.1177/01945998211037541 ◽

2021 ◽

pp. 019459982110375

Author(s):

Michael Hartley Freeman ◽

Justin R. Shinn ◽

Shanik J. Fernando ◽

Douglas Totten ◽

Jaclyn Lee ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Head And Neck ◽

Free Flap ◽

Frailty Index ◽

Multiple Logistic Regression Analysis ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Preoperative Risk ◽

Preoperative Risk Factors

Objective To determine the preoperative risk factors most predictive of prolonged length of stay (LOS) or admission to a skilled nursing facility (SNF) or inpatient rehabilitation center (IPR) after free flap reconstruction of the head and neck. Study Design Retrospective cohort study. Setting Tertiary academic medical center. Methods Retrospective review of 1008 patients who underwent tumor resection and free flap reconstruction of the head and neck at a tertiary referral center from 2002 to 2019. Results Of 1008 patients (65.7% male; mean age of 61.4 years, SD 14.0 years), 161 (15.6%) were discharged to SNF/IPR, and the median LOS was 7 days. In multiple linear regression analysis, Charlson Comorbidity Index (CCI; P < .001), American Society of Anesthesiologists (ASA) classification ( P = .021), female gender ( P = .023), and inability to tolerate oral diet preoperatively ( P = .006) were statistically significantly related to increased LOS, whereas age, body mass index (BMI), modified frailty index (MFI), a history of prior radiation or chemotherapy, and home oxygen use were not. Multiple logistic regression analysis demonstrated that CCI (odds ratio [OR] = 1.119, confidence interval [CI] 1.023-1.223), age (OR = 1.082, CI 1.056-1.108), and BMI <19.0 (OR = 2.141, CI 1.159-3.807) were the only variables statistically significantly related to posthospital placement in an SNF or IPR. Conclusion Common tools for assessing frailty and need for additional care may be inadequate in a head and neck reconstructive population. CCI appears to be the best of the aggregate metrics assessed, with significant relationships to both LOS and placement in SNF/IPR.

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