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.

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.

scholarly journals Availability of preoperative neutrophil-lymphocyte ratio to predict postoperative delirium after head and neck free-flap reconstruction: A retrospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254654
Author(s):  
Hirotaka Kinoshita ◽  
Junichi Saito ◽  
Daiki Takekawa ◽  
Tasuku Ohyama ◽  
Tetsuya Kushikata ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Intensive Care ◽  
Head And Neck ◽  
Logistic Regression Analysis ◽  
Free Flap ◽  
Postoperative Delirium ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Neutrophil Lymphocyte Ratio

Postoperative delirium (POD) is a well-recognized postoperative complication and is associated with increased morbidity and mortality. We investigated whether the preoperative neutrophil-lymphocyte ratio (NLR) could be an effective predictor of POD after head and neck free-flap reconstruction. This was a single-center, retrospective, observational study. We analyzed the perioperative data of patients who had undergone elective head and neck free-flap reconstruction surgery. POD was assessed with the Intensive Care Delirium Screening Checklist (ICDSC) during admission to our intensive care unit (ICU). POD was defined as an ICDSC score ≥4. Risk factors for POD were evaluated by univariate and multivariate logistic regression analysis. We included 97 patients. The incidence of POD was 20.6% (20/97). Significantly longer ICU stays were observed in the patients with POD compared to those without POD (median [interquartile range]: 5 [4–6] vs. 4 [4–5], p = 0.031). Higher preoperative NLR values (3 <NLR ≤4 and 4 <NLR) were significantly associated with higher ICDSC scores compared to NLR ≤1 (4 [2–4] vs. 1 [1–1], p = 0.027 and 4 [1–4] vs. 1 [1–1], p = 0.038, respectively). The multivariable logistic regression analysis revealed that only a preoperative NLR >3.0 (adjusted Odds Ratio: 23.6, 95% Confidence Interval: 6.6–85.1; p<0.001) was independently associated with POD. The multivariate area under the receiver operator curve was significantly greater for the E-PRE-DELIRIC model with NLR compared to the E-PRE-DELIRIC model (0.87 vs. 0.60; p<0.001). The preoperative NLR may be a good predictor of POD in patients undergoing head and neck free-flap reconstruction.

Skeletal Muscle Index’s Impact on Discharge Disposition After Head and Neck Cancer Free Flap Reconstruction

2020 ◽  
pp. 019459982097323
Author(s):  
Alexander Joseph Jones ◽  
Vincent Joseph Campiti ◽  
Mohamedkazim Alwani ◽  
Leah J. Novinger ◽  
Andrea Bonetto ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Logistic Regression ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Stage Iv ◽  
Binary Logistic Regression ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Discharge Disposition

Objective To determine the role of skeletal muscle index (SMI) in the assessment of frailty and determination of discharge to post–acute care facilities (PACF) after head and neck cancer free flap reconstruction (HNCFFR). Study Design Retrospective cohort. Setting Single-institution, academic tertiary referral center. Methods Adult patients undergoing HNCFFR from 2014 to 2019 with preoperative abdominal computed tomography imaging were retrospectively analyzed. Patient demographics, 5-factor modified frailty index (5-mFI), body mass index (BMI), SMI at the third lumbar vertebra, oncologic history, perioperative data, and Clavien-Dindo (CD) complications were collected. Binary logistic regression was used to identify independent predictors of discharge disposition. Results The cohort consisted of 206 patients, 62 (30.1%) of whom were discharged to PACF. Patients discharged to PACF were of older age (65.4 vs 57.1 years, P < .0001) and had a lower SMI (38.8 vs 46.8 cm2/m2, P < .0001), higher 5-mFI (≥3; 25.8% vs 4.2%, P < .0001), and greater incidence of stage IV (80.6% vs 64.1%, P = .0211) aerodigestive cancer (80.6% vs 66.7%, P = .0462). Patients discharged to PACF experienced more blood transfusions (74.2% vs 35.4%, P < .0001), major postoperative complications (CD ≥3, 40.3% vs 12.9%, P < .0001), and delirium (33.9% vs 4.2%, P < .0001). After adjusting for pre- and postoperative factors, multivariate binary logistic regression identified age ( P = .0255), 5-mFI ( P < .0042), SMI ( P = .0199), stage IV cancer ( P = .0250), aerodigestive tumor ( P = .0366), delirium ( P < .0001), and perioperative blood transfusion ( P = .0144) as independent predictors of discharge to PACF. Conclusions SMI and 5-mFI are independently associated with discharge to PACF after HNCFFR and should be considered in preoperative planning and assessment of frailty.

Octogenarian Free Flap Reconstruction: Complications and Cost of Therapy

2002 ◽  
Vol 126 (3) ◽  
pp. 301-306 ◽  
Author(s):  
Keith E. Blackwell ◽  
Babak Azizzadeh ◽  
Carlos Ayala ◽  
Jeffrey D. Rawnsley
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Tertiary Care ◽  
Medical Complications ◽  
Head And Neck Reconstruction ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Younger Patients ◽  
Neck Reconstruction ◽  
The Cost

OBJECTIVE: The study goal was to document the reliability, incidence of complications, and cost of therapy for patients older than 80 years who undergo microvascular head and neck reconstruction. PATIENTS AND METHODS: Thirteen octogenarians underwent free flap reconstruction of defects resulting from the treatment of head and neck cancer at an academic tertiary care medical center. The incidence of medical and reconstructive complications and the cost of hospitalization were compared with those for 99 younger patients who were treated during the same time period. RESULTS: There were no cases of free flap failure or significant reconstructive complications in the octogenarians. The incidence of medical complications was 62% in the octogenarians and 15% in the younger patients. The average cost of therapy was $54,702 per octogenarian patient compared with $30,397 per younger patient. The increased incidence of medical complications and increased cost arose primarily from an increased severity of preoperative systemic illness in the octogenarians. However, controlling for comorbidity did not eliminate the discrepancy in medical complications between the octogenarians and the younger patients. CONCLUSIONS: Although microvascular head and neck reconstruction in the elderly is very reliable, the incidence of medical complications and the cost of therapy are significantly increased in octogenarians.

Free Flap Reconstruction in the Head and Neck. Indications, Technical Aspects and Outcomes

2014 ◽  
Vol 65 (1) ◽  
pp. 33-42
Author(s):  
José Luis Llorente ◽  
Fernando López ◽  
Vanessa Suárez ◽  
Ángel Fueyo ◽  
Susana Carnero ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Technical Aspects

Assessing the Influence of Failed Implant Reconstruction on Patient Satisfaction and Decision Regret after Salvage Free-Flap Breast Reconstruction

2021 ◽  
Author(s):  
Ronnie L. Shammas ◽  
Amanda R. Sergesketter ◽  
Mahsa Taskindoust ◽  
Sonali Biswas ◽  
Scott T. Hollenbeck ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Breast Reconstruction ◽  
Free Flap ◽  
Well Being ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Decision Regret ◽  
History Of ◽  
Implant Reconstruction

Abstract Background Free-flap breast reconstruction after failed implant reconstruction is associated with improved patient outcomes. How the level of satisfaction achieved compares between patients with and without previously failed implant reconstruction remains unknown. The aim of this study was to assess the influence of prior failed implant-based reconstruction on long-term patient-reported outcomes after free-flap breast reconstruction. Methods All patients undergoing free-flap breast reconstruction between 2015 and 2019 were identified. Patient satisfaction using the BREAST-Q and decisional regret using the Decision Regret Scale were compared between patients with and without a history of implant breast reconstruction. Results Overall, 207 patients were contacted and 131 completed the BREAST-Q and Decision Regret Scale. A total of 23 patients had a history of failed implant-based reconstruction requiring free-flap-flap salvage, most commonly due to infection (39.1%), chronic pain (34.8%), capsular contracture (26%), and implant malposition (26.1%). Following definitive free-flap reconstruction, patients with prior failed implant reconstruction had significantly lower BREAST-Q scores for satisfaction with breast (61.2 ± 16.7 vs. 70.4 ± 18.7; p = 0.04) and sexual well-being (38.5 ± 18.2 vs. 52.8 ± 24.7; p = 0.01) and reported higher decision regret (19.1 ± 18.6 vs. 9.6 ± 15.6, respectively). There were no significant differences for psychosocial well-being (p = 0.67), physical well-being (chest; p = 0.27), and physical well-being (abdomen; p = 0.91). Conclusion A history of failed implant-based reconstruction is associated with reduced satisfaction and increased decision regret with the final reconstructive outcome. This data underscores the importance of appropriate patient selection at the initial consultation, and informed preoperative counseling regarding long-term outcomes in patients presenting for free-flap reconstruction after a failed implant-based reconstruction.

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