Postoperative Tachycardia in Head and Neck Microvascular Free Flap Patients

2019 ◽  
Vol 160 (6) ◽  
pp. 1019-1022 ◽  
Author(s):  
Andrea Ziegler ◽  
Alexander Schneider ◽  
Amy Pittman ◽  
Eric Thorpe
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Vascular Complication ◽  
Adverse Outcomes ◽  
Free Flap Surgery ◽  
Increased Risk ◽  
Microvascular Free Flap

Objective The goal of this study was to determine the incidence of postoperative tachycardia and its predictive value of complications in patients following microvascular free flap surgery in the head and neck. Study Design Retrospective chart review. Setting Single tertiary care academic medical center. Subjects and Methods All patients who underwent a microvascular free flap of the head and neck by surgeons in the department of otolaryngology from 2013 to 2017 were included in this study. Results Of the 344 who patients met inclusion criteria, 40.4% had a maximum heart rate (HR) of the hospitalization over 110 beats per minute (bpm). Patients with a maximum HR greater than 110 bpm were 19 times more likely to experience a composite vascular complication (myocardial infarction, myocardial necrosis, or pulmonary embolism) than patients with a maximum HR <110 bpm ( P = .0063). Patients with a history of chronic kidney disease were also noted to have an increased risk of experiencing a postoperative composite vascular event. Conclusion Postoperative tachycardia is significantly associated with adverse outcomes and should not be dismissed as a normal variant. Identifying patients at an increased risk of having an underlying complication can help guide interpretation, workup, and management of postoperative patients in the head and neck population.

Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

2018 ◽  
Vol 159 (5) ◽  
pp. 817-823 ◽  
Author(s):  
Meghan M. Crippen ◽  
Jacob S. Brady ◽  
Alexander M. Mozeika ◽  
Jean Anderson Eloy ◽  
Soly Baredes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Increased Risk

Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.

Survival Predictors of Head and Neck Burkitt’s Lymphoma: An Analysis of the SEER Database

2021 ◽  
pp. 019459982110415
Author(s):  
Salma Ahsanuddin ◽  
Joshua B. Cadwell ◽  
Neel R. Sangal ◽  
Jordon G. Grube ◽  
Christina H. Fang ◽  
...  
Keyword(s):  
Head And Neck ◽  
Cox Regression ◽  
Medical Center ◽  
Academic Medical Center ◽  
Population Level ◽  
Burkitt’S Lymphoma ◽  
Burkitt's Lymphoma ◽  
Seer Database ◽  
Increased Risk ◽  
Ann Arbor

Objective To analyze population-level data for Burkitt’s lymphoma of the head and neck. Study Design Retrospective study of a national cancer database. Setting Academic medical center. Methods The SEER database (Surveillance, Epidemiology, and End Results) identified all patients with primary Burkitt’s lymphoma of the head and neck from 1975 to 2015. Demographic, clinicopathologic, and treatment characteristics were analyzed. Multivariable Cox regressions analyzed factors associated with survival while controlling for baseline differences. Results A total of 920 patients with a mean (SD) age of 37.6 years (25.0) were identified. A majority of patients were White (82.8%) and male (72.3%). The most primary common sites included the lymph nodes (61.3%), pharynx (17.7%), and nasal cavity/paranasal sinuses (5.2%). The majority of patients received chemotherapy (90.5%), while fewer underwent surgery (42.1%) or radiotherapy (12.8%). Choice of treatment differed significantly among patients of different ages, year of diagnosis, primary site, nodal status, and Ann Arbor stage. Overall 10-year survival was 67.8%. On multivariable Cox regression, patients with older age (hazard ratio [HR], 1.05 per year; P < .001) and higher stage at presentation had increased risk of mortality ( P < .001). Furthermore, cases diagnosed between 2006 and 2015 (HR, 0.35; P < .001) and 1996 and 2005 (HR, 0.53; P = .001) had lower mortality when compared with those diagnosed between 1975 and 1995. Treatment including surgery and chemotherapy tended to have the best survival ( P < .001). Conclusion Burkitt’s lymphoma of the head and neck diagnosed in more recent years has had improved survival. Factors significantly associated with survival include age, Ann Arbor stage, and treatment regimen. Treatment including surgery and chemotherapy was associated with the highest survival.

Discharge Delay in Head and Neck Free Flap Surgery: Risk Factors and Strategies to Minimize Hospital Days

2019 ◽  
Vol 160 (5) ◽  
pp. 829-838 ◽  
Author(s):  
Dustin M. Lang ◽  
Deepa Danan ◽  
Raja Sawhney ◽  
Natalie L. Silver ◽  
Varun V. Varadarajan ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Quality Metric ◽  
Factors Associated ◽  
Free Flap Surgery ◽  
Hospital Resources ◽  
Hospital Days

Objective Length of stay (LOS) includes time medically necessary in the hospital and time waiting for discharge (DC) afterward. This DC delay is determined in head and neck free flap patients. Reasons for and factors leading to DC delay, as well as associated adverse outcomes, are elucidated. Methods Retrospective chart review was performed for all head and neck free flap surgeries from 2012 to 2017. Data including demographics, comorbidities, and perioperative factors were collected. Regression analyses were performed to identify factors associated with DC delay. Results In total, 264 patients were included. Mean total LOS was 13.1 days. DC delay occurred in 65% of patients with a mean of 4.8 days. Factors associated with DC delay on univariate analysis included Medicaid/self-pay insurance, DC to a facility, and not having children ( P < .05). Multivariate analysis showed prolonged medically necessary LOS and surgery on a Monday/Friday ( P < .05) were associated with DC delay. Top reasons for DC delay included case management shortages, rejection by facility, and awaiting supplies. Eleven percent experienced complications during the DC delay. Discussion DC delay can add days and complications to the LOS. Prevention begins preoperatively with DC planning involving the patient’s closest family. Understanding limitations of the patient’s insurance may help plan DC destination. Optimizing hospital resources when available should be a focus. Implications for Practice Head and neck free flap patients require a team of teams unified in optimizing quality of care. DC delay is a novel quality metric reflecting the team’s overall performance. Through strategic DC planning and capitalizing on available resources, DC delay can be minimized.

scholarly journals NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

OTO Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 2473974X1668569 ◽  
Author(s):  
Charles A. Riley ◽  
Blair M. Barton ◽  
Claire M. Lawlor ◽  
David Z. Cai ◽  
Phoebe E. Riley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Flap Surgery ◽  
Improvement Program ◽  
Free Flap Surgery ◽  
The Mean

Objective The National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost-effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses. Methods A case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center. Comorbidities and intraoperative and postoperative variables were collected. Predicted length of stay was tabulated with the NSQIP calculator. Results Thirty-five patients (70%) were male. The mean (SD) age was 67.2 (13.4) years. The mean (SD) length of stay (LOS) was 13.5 (10.3) days. The mean (SD) NSQIP-predicted LOS was 10.3 (2.2) days ( P = .027). Discussion The NSQIP calculator may be an inadequate predictor for LOS in patients with HNC undergoing free flap surgery. Additional study is necessary to determine the accuracy of this tool in this patient population. Implications for Practice: Head and neck surgeons performing free flap reconstructive surgery following tumor ablation may find that the NSQIP risk calculator underestimates the LOS in this population.

Microvascular free flaps in head and neck surgery

1994 ◽  
Vol 108 (11) ◽  
pp. 962-968 ◽  
Author(s):  
Marcelle Macnamara ◽  
Sarah Pope ◽  
A. Sadler ◽  
H. Grant ◽  
M. Brough
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Neck Region ◽  
Free Flaps ◽  
Neck Surgery ◽  
Flap Failure ◽  
Free Flap Surgery ◽  
Wide Range ◽  
Radial Forearm ◽  
Microvascular Free Flap

AbstractThis study is a retrospective review of 60 patients who had microvascular free flap reconstructions in the head and neck region. They were all performed over a 10-year period by a single surgeon. The series includes a wide range of flap types and analyses pre-operative risk factors for flap failure as well as complications and outcome. Smoking and advanced age did not appear to prejudice flap survival but peripheral vascular disease, cardiac disease and alcohol withdrawal were found to increase the likelihood of flap failure. The most frequent complications encountered were thrombosis of one of the anastomosis and haematoma. The most successful flap in terms of survival and function was the fasciocutaneous radial forearm flap. The literature is reviewed in relation to the general principles of microvascular free flap surgery and the results of this series are placed in context.

scholarly journals Adverse Outcomes Following Free Tissue Transfer: A 3-year Experience From a Major Referral Centre

2021 ◽  
Author(s):  
Silas Nann ◽  
Jia Miin Yip ◽  
Tyler Glanville ◽  
Nicholas Marshall
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Case Series ◽  
Free Flaps ◽  
Adverse Outcomes ◽  
The Body ◽  
Complication Rates ◽  
Retrospective Case ◽  
Tissue Transfer ◽  
Free Flap Surgery

Abstract BackgroundFree tissue transfer encompasses a variety of techniques by which tissue is moved to another region of the body, with anastomosis of the divided artery and vein. Currently, success rates are reported at 91-99% [1], however, little is known regarding predictors for adverse outcomes.We aim at identifying predictors for negative outcomes following free flap surgery; and predict that elderly patients and patients with head and neck free flaps will have inferior outcomes due to comorbidity.MethodsThis is a retrospective case series. All free flap surgeries between 02/2018 to 02/2021 were identified using the electronic operation record system at Flinders Medical Centre. Chi squared hypothesis testing assessed patient factors and implications on outcome. Results67 patients of varying demographics were included in this study. The odds of wound infection was much higher in patients aged older than 65 (OR: 4.1 (95%CI 1.24-13.6, z-score: 2.31, p=0.017)). The odds of unplanned reoperation was also higher in this population (OR: 13.7 (95%CI 1.42-132.9, p=0.0053)). Free flap location was significant in determining whether patients would require a subsequent blood transfusion (p=0.0071). Head and neck patients did not experience a higher rate of adverse events.ConclusionPatients aged 65 and older are more likely to require treatment for infection and more often require reoperation because of flap related issues. Patients with limb free flaps are more likely to require transfusions. Head and neck patients did not have higher complication rates.

scholarly journals Role of heparin in microvascular free flap surgery in head and neck reconstruction

2015 ◽  
pp. 534-538
Author(s):  
Gunjan Agrawal ◽  
Ashutosh Gupta ◽  
Vivek Choudhary ◽  
Santanu Tiwari ◽  
Kshitij Verma ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Flap Surgery ◽  
Neck Reconstruction ◽  
Free Flap Surgery ◽  
Microvascular Free Flap

Outcomes in Head and Neck Free Flap Reconstruction Among Patients With a History of Venous Thromboembolism

2021 ◽  
pp. 019459982110119
Author(s):  
Meghan M. Crippen ◽  
Rohan S. Ganti ◽  
Vivian Xu ◽  
Brian Swendseid ◽  
Diana L. Tzeng ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Venous Thromboembolism ◽  
Head And Neck ◽  
Free Flap ◽  
Tertiary Care ◽  
Binary Logistic Regression ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Increased Risk ◽  
History Of

Objective To investigate if a history of venous thromboembolism (VTE) is a risk factor for complications in head and neck free flap surgery by assessing outcomes among patients with a history of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Study Design Retrospective cohort study. Setting Single tertiary care center. Methods All patients undergoing head and neck free flap reconstruction at our institution between September 1, 2006, and April 2, 2020, were assessed for inclusion. Patients with and without a history of DVT or PE preoperatively were identified and grouped for comparison. Groups were compared for demographics, comorbidities, and 30-day complications. Significance was assessed with chi-square and binary logistic regression analyses. Results Of the 1061 patients meeting inclusion criteria, 40 (3.8%) had a history of VTE. These patients were significantly older (mean [SD], years: 67.8 [11.7] vs 63.0 [14.1], P = .038) and significantly more likely to have history of chemotherapy (35.0% vs 18.7%, P = .010) and stroke (27.5% vs 4.5%, P < .001). After accounting for patient characteristics via binary logistic regression, VTE was independently associated with an increased risk for postoperative thrombosis of the free flap pedicle (odds ratio [95% CI] = 3.65 [1.12-11.90], P = .032) and reoperation (2.45 [1.25-4.80], P = .009). Patients with history of PE had a significantly increased risk for flap failure (7.70 [1.77-33.52], P = .007). Prior VTE was not independently associated with an increased risk for medical complications or readmission. Conclusion Patients with a history of VTE may be at an increased risk for free flap compromise secondary to postoperative pedicle thrombosis. This risk should be considered in preoperative workup and postoperative monitoring.

Head and Neck Free Flap Reconstruction in an Academic versus a Community Setting

2021 ◽  
Author(s):  
Joseph Lewcun ◽  
Sameer Massand ◽  
John Trangucci ◽  
Chan Shen ◽  
Timothy S. Johnson
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Community Hospital ◽  
Medical Center ◽  
Academic Medical Center ◽  
Community Setting ◽  
University Hospital ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
The University

Abstract Background Head and neck free flap reconstructions are complex procedures requiring extensive resources, and have the potential to be highly morbid. As such, it is imperative that they should be performed in an appropriate setting, optimizing outcomes while limiting morbidity. The aim of this study is to identify any disparities in the treatment outcomes of patients undergoing head and neck free flap reconstruction by a single surgeon in an academic versus a community hospital setting. Methods A retrospective review of all patients who underwent head and neck free flap reconstruction for any indication by a single surgeon from 2009 to 2019 was conducted. All surgeries were performed at one of two hospitals: one academic medical center and one community hospital. Demographics and rates of partial or complete flap failure, medical complications, surgical complications, mortality, and other secondary outcomes were compared between the two settings. Results Ninety-two patients who underwent head and neck free flap reconstruction were included. Fifty-seven (62%) of free flap reconstructions were performed in the academic medical center, while 35 (38%) were performed in the community hospital. There were no significant differences in complete flap loss, either intraoperative or postoperative (p = 0.5060), partial flap loss (p = 0.5827), postoperative surgical complications (p = 0.2930), or medical complications (p = 0.7960) between groups. The in-hospital mortality rate was 0% (n = 0) at the university hospital as compared with 5.7% at the community hospital (p = 0.0681). The mean operative time was 702.3 minutes at the university hospital and 606.3 minutes at the community hospital (p = 0.0080). Conclusion Head and neck free flap surgery can be performed safely in either an academic or a community setting, with no difference in primary outcomes of surgery. Preferential selection of either treatment setting should be based on consideration of patient needs and availability of auxiliary specialty services.

Sign in / Sign up

Export Citation Format

Share Document