Does stroke volume increase after a fluid challenge? A study on the management of patients undergoing major head and neck free flap surgery: preliminary data

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.

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Italian cost analysis of free flap surgery in head and neck reconstruction using the activity-based costing (ABC)

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.10.096 ◽

2020 ◽

Author(s):

Karim Tewfik ◽

Pasquale Chiarelli ◽

Chiara Copelli ◽

Nicola Pederneschi ◽

Lazzaro Cassano ◽

...

Keyword(s):

Cost Analysis ◽

Head And Neck ◽

Free Flap ◽

Head And Neck Reconstruction ◽

Activity Based Costing ◽

Flap Surgery ◽

Neck Reconstruction ◽

Free Flap Surgery

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Complications following head and neck free flap surgery: do we need a standardized classification?

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2012.04.173 ◽

2012 ◽

Vol 50 ◽

pp. S11

Author(s):

L. Dunphy ◽

V. Sood ◽

W.S. Hislop

Keyword(s):

Head And Neck ◽

Free Flap ◽

Flap Surgery ◽

Free Flap Surgery

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Does Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1606346 ◽

2017 ◽

Vol 34 (02) ◽

pp. 087-094 ◽

Cited By ~ 6

Author(s):

Jinglong Liu ◽

Quan Shi ◽

Shuo Yang ◽

Bo Liu ◽

Bin Guo ◽

...

Keyword(s):

Head And Neck ◽

Free Flap ◽

Meta Analysis ◽

Anticoagulation Therapy ◽

Head And Neck Reconstruction ◽

Thromboembolic Events ◽

Flap Surgery ◽

Neck Reconstruction ◽

Flap Loss ◽

Free Flap Surgery

Background Due to limited evidence, it is unclear whether postoperative anticoagulation therapy may lead to higher success rates for microvascular free-flap surgery in the head and neck. This review evaluated whether postoperative anticoagulation therapy can lead to a better result in head and neck reconstruction. Methods PubMed, Embase, and the Cochrane Library were used to search for articles on the efficacy of postoperative antithrombotic therapy in free-flap transfer during head and neck reconstruction without language restrictions in February of 2017. A random-effects model was used to estimate the relative risk ratio (RR) with 95% confidence intervals (CIs). The measured outcomes were flap loss, thromboembolic events, and hematoma formation. Results A total of 2,048 free-flap surgery procedures in the head and neck were analyzed. There was no significant difference in the occurrence of flap loss and thromboembolic events in the anticoagulation group compared with the nonanticoagulation group (RR = 1.25, 95% CI = 0.85–1.81, p = 0.26; and RR = 1.05, 95% CI = 0.74–1.48, p = 0.79, respectively). The risk of hematoma was twice as high in the anticoagulation group than the nonanticoagulation group, which was statistically significant (RR = 2.02, 95% CI = 1.08–3.76, p = 0.03). Conclusion The findings from our meta-analysis indicate that postoperative anticoagulation therapy barely decreases the risks of flap loss and thromboembolic events in free-flap surgery in the head and neck. However, it may significantly increase the risk of hematoma formation. Considering the limitations of this meta-analysis, additional high-quality, multicenter, prospective, randomized controlled studies are needed to confirm these findings.

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HN01ï¿½TEN YEAR REVIEW OF HEAD AND NECK FREE FLAP SURGERY IN AUCKLAND

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2009.04919_1.x ◽

2009 ◽

Vol 79 ◽

pp. A37-A37

Author(s):

S. S. Li ◽

J. Chaplin

Keyword(s):

Head And Neck ◽

Free Flap ◽

Flap Surgery ◽

Free Flap Surgery

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Avoiding Complications in Free Flap Surgery

Otolaryngology ◽

10.1016/s0194-5998(05)80056-7 ◽

1995 ◽

Vol 112 (5) ◽

pp. P38-P38

Author(s):

Neal D. Futran ◽

Jeffrey R. Haller

Keyword(s):

Head And Neck ◽

Free Flap ◽

Postoperative Care ◽

Preoperative Planning ◽

Head And Neck Reconstruction ◽

Flap Surgery ◽

Educational Objectives ◽

Neck Reconstruction ◽

Free Flap Surgery

Educational objectives: To avoid complications in microvascular head and neck reconstruction by having a better understanding of patient and flap selection, preoperative planning, postoperative care, and monitoring and to delineate the techniques and procedures to manage free flap complications when they occur.

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