Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: a retrospective observational series.

Burkhard, John-Patrik; Pfister, Jelena; Giger, Roland; Huber, Markus; Lädrach, Claudia; Waser, Manuel; Olariu, Radu; Engel, Dominique; Löffel, M.; Schaller, Benoît; Wüthrich, Patrick Y. (2021). Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: a retrospective observational series. Clinical oral investigations, 25(9), pp. 5541-5550. Springer 10.1007/s00784-021-03864-1

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OBJECTIVES

The aim of this study was to determine the influence of perioperative fluid management and administration of vasopressors on early surgical revision and flap-related complications in free tissue transfer.

MATERIALS AND METHODS

Intraoperative amount of fluid and of vasopressors, relevant perioperative parameters, and comorbidities were recorded in 131 patients undergoing head and neck microvascular reconstruction and compared with early surgical complications, defined as interventions requiring surgery after a flap-related complication, and/or other surgical problems in the operating room within 30 days after initial surgery. The relationship between perioperative variables for each revision category was determined using an optimized multiple logistic regression.

RESULTS

The administration of diuretics (p=0.001) as a treatment for perioperative fluid overload and the type of flap (p=0.019) was associated with a higher risk of early surgical revisions. Perioperative fluid overload (p=0.039) is significantly related to flap-related complications. We found no effect of intraoperative administration of vasopressors on early surgical revisions (p=0.8) or on flap-related complications (norepinephrine p=0.6, dobutamine p=0.5).

CONCLUSION

Perioperative fluid overload is associated with higher risks of early surgical revision and flap-related complications. In contrast, the administration of vasopressors seemed to have no effect on either surgical revision rate or flap-related complications.

CLINICAL RELEVANCE

In patients receiving microvascular reconstructions, a balanced fluid administration perioperatively and a targeted use of vasopressors should be the necessary strategy to reduce the complication rates in head and neck surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Craniomaxillofacial Surgery
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Plastic, Reconstructive and Aesthetic Surgery
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery

UniBE Contributor:

Burkhard, John Patrik Matthias; Pfister, Jelena Elisa; Giger, Roland; Huber, Markus; Lädrach, Claudia Stephanie; Waser, Manuel Nicola; Olariu, Radu; Engel, Dominique; Löffel, Lukas; Schaller, Benoît and Wüthrich, Patrick Yves

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1436-3771

Publisher:

Springer

Language:

English

Submitter:

Veronika Picha

Date Deposited:

28 Apr 2021 19:20

Last Modified:

19 Aug 2021 01:32

Publisher DOI:

10.1007/s00784-021-03864-1

Related URLs:

PubMed ID:

33686470

Uncontrolled Keywords:

Fluid overload Free flap Revision surgery Vasopressor

BORIS DOI:

10.48350/154210

URI:

https://boris.unibe.ch/id/eprint/154210

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