Abstract
The aim of this study was to assess the impact of the different subtypes of patient comorbidities on the outcomes of head and neck microvascular reconstruction. A total of 423 patients who underwent head and neck free flap reconstruction in our institution between 2000 and 2010 were included in this retrospective study. The impact of the different subtypes of patient comorbidities (as defined by the Kaplan–Feinstein Index) and other global health status-related factors on free flap success, local and general complications, postoperative mortality and length of stay was assessed in univariate and multivariate analysis. We found no correlation between patient comorbidities and free flap failure. In multivariate analysis, we demonstrated a significant correlation between tobacco consumption (p = 0.04) and local complications. Gastro-intestinal comorbidity (p = 0.005) and malnutrition (p = 0.02) were associated with a higher risk of fistula formation. Diabetes mellitus (p = 0.003), gastro-intestinal (p = 0.02), systemic (p = 0.02) and cardiac comorbidities (p = 0.03) were significant predictors of medical complications. We concluded that the different subtypes of patient comorbidities were relevant predictors of complications in head and neck microvascular reconstruction.
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Bozec A, Poissonnet G, Converset S et al (2007) Mandibular reconstruction with osseous free flaps: functional results. Ann Otolaryngol Chir Cervicofac 124:16–24
Bozec A, Poissonnet G, Chamorey E et al (2009) Quality of life after oral and oropharyngeal reconstruction with a radial forearm free flap: prospective study. J Otolaryngol Head Neck Surg 38:401–408
Bak M, Jacobson AS, Buchbinder D, Urken ML (2010) Contemporary reconstruction of the mandible. Oral Oncol 46:71–76
Dean NR, Wax MK, Virgin FW, Magnuson JS, Carroll WR, Rosenthal EL (2012) Free flap reconstruction of lateral mandibular defects: indications and outcomes. Otolaryngol Head Neck Surg 146:547–552
Bozec A, Poissonnet G, Chamorey E et al (2008) Free-flap head and neck reconstruction and quality of life: a 2-year prospective study. Laryngoscope 118:874–880
Bozec A, Poissonnet G, Converset S et al (2007) Head and neck reconstructive surgery with free flaps and quality of life: a prospective study. Rev Laryngol Otol Rhinol (Bord) 128:11–18
Dassoville O, Poissonnet G, Chamorey E et al (2008) Head and neck reconstruction with free flaps: a report on 213 cases. Eur Arch Otorhinolaryngol 265:85–95
Bozec A, Poissonnet G, Chamorey E et al (2009) Transoral and cervical approach without mandibulotomy for oropharynx cancer with fasciocutaneous radial forearm free flap reconstruction. Ann Otolaryngol Chir Cervicofac 126:182–189
Ferrier MB, Spuesens EB, Le Cessie S, Baatenburg de Jong RJ (2005) Comorbidity as a major risk factor for mortality and complications in head and neck surgery. Arch Otolaryngol Head Neck Surg 131:27–32
Patel RS, McCluskey SA, Goldstein DP et al (2010) Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck. Head Neck 32:1345–1353
Rosenberg AJ, Van Cann EM, van der Bilt A, Koole R, van Es RJ (2009) A prospective study on prognostic factors for free-flap reconstructions of head and neck defects. Int J Oral Maxillofac Surg 38:666–670
Haughey BH, Wilson E, Kluwe L et al (2001) Free flap reconstruction of the head and neck: analysis of 241 cases. Otolaryngol Head Neck Surg 125:10–17
Suh JD, Sercarz JA, Abemayor E et al (2004) Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 130:962–966
Clark JR, McCluskey SA, Hall F et al (2007) Predictors of morbidity following free flap reconstruction for cancer of the head and neck. Head Neck 29:1090–1101
Kaplan MH, Feinstein AR (1974) The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus. J Chron Dis 27:387–404
Datema FR, Poldermans D, Baatenburg de Jong RJ (2010) Incidence and prediction of major cardiovascular complications in head and neck surgery. Head Neck 32:1485–1493
Kruse AL, Luebbers HT, Grätz KW, Obwegeser JA (2010) Factors influencing survival of free-flap in reconstruction for cancer of head and neck: a literature review. Microsurgery 30:242–248
David S, Dassonville O, Poissonnet G et al (2011) Free-flap head and neck reconstruction failures: predictive factors and management. Ann Chir Plast Esthet 56:308–314
Nao EE, Dassonville O, Chamorey E et al (2009) Head and neck free-flap reconstruction in the elderly. Eur Ann Otorhinolaryngol Head Neck Dis 128:47–51
Bozikov K, Arnez ZM (2006) Factors predicting free flap complications in head and neck reconstruction. J Plast Reconstr Aesthet Surg 59:737–742
Wild T, Rahbarnia A, Kellner M, Sobotka L, Eberlein T (2010) Basics in nutrition and wound healing. Nutrition 26:862–866
Bianchini C, Ciorba A, Stomeo F, Pelucchi S, Pastore A (2012) Immunonutrition in head and neck cancer: have a look before surgery! Eur Arch Otorhinolaryngol 269:5–8
Bohannon IA, Carroll WR, Magnuson JS, Rosenthal EL (2011) Closure of post-laryngectomy pharyngocutaneous fistulae. Head Neck Oncol 3:29
Seikaly H, Park P (1995) Gastroesophageal reflux prophylaxis decreases the incidence of pharyngocutaneous fistula after total laryngectomy. Laryngoscope 105:1220–1222
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Vandersteen, C., Dassonville, O., Chamorey, E. et al. Impact of patient comorbidities on head and neck microvascular reconstruction. A report on 423 cases. Eur Arch Otorhinolaryngol 270, 1741–1746 (2013). https://doi.org/10.1007/s00405-012-2224-z
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DOI: https://doi.org/10.1007/s00405-012-2224-z