Hand William R, McSwain Julie R, McEvoy Matthew D, Wolf Bethany, Algendy Abdalrahman A, Parks Matthew D, Murray John L, Reeves Scott T
Medical University of South Carolina, Charleston, South Carolina, USA
Medical University of South Carolina, Charleston, South Carolina, USA.
Otolaryngol Head Neck Surg. 2015 Mar;152(3):480-7. doi: 10.1177/0194599814564366. Epub 2014 Dec 30.
To investigate the association between perioperative patient characteristics and treatment modalities (eg, vasopressor use and volume of fluid administration) with complications and failure rates in patients undergoing head and neck free tissue transfer (FTT).
A retrospective review of medical records.
Perioperative hospitalization for head and neck FTT at 1 tertiary care medical center between January 1, 2009, and October 31, 2011.
Consecutive patients (N=235) who underwent head and neck FTT. Demographic, patient characteristic, and intraoperative data were extracted from medical records. Complication and failure rates within the first 30 days were collected
In a multivariate analysis controlling for age, sex, ethnicity, reason for receiving flap, and type and volume of fluid given, perioperative complication was significantly associated with surgical blood loss (P=.019; 95% confidence interval [CI], 1.01-1.16), while the rate of intraoperative fluid administration did not reach statistical significance (P=.06; 95% CI, 0.99-1.28). In a univariate analysis, FTT failure was significantly associated with reason for surgery (odds ratio, 5.40; P=.03; 95% CI, 1.69-17.3) and preoperative diagnosis of coronary artery disease (odds ratio, 3.60; P=.03; 95% CI, 1.16-11.2). Intraoperative vasopressor administration was not associated with either FTT complication or failure rate.
FTT complications were associated with surgical blood loss but not the use of vasoactive drugs. For patients undergoing FTT, judicious monitoring of blood loss may help stratify the risk of complication and failure.
探讨头颈部游离组织移植（FTT）患者围手术期特征及治疗方式（如血管活性药物使用和液体输注量）与并发症及失败率之间的关联。
对病历进行回顾性分析。
2009年1月1日至2011年10月31日期间，在一家三级医疗中心对头颈部FTT患者进行围手术期住院治疗。
连续纳入235例行头颈部FTT的患者。从病历中提取人口统计学、患者特征及术中数据。收集术后30天内的并发症及失败率。
在多因素分析中，控制年龄、性别、种族、接受皮瓣的原因以及给予的液体类型和量后，围手术期并发症与手术失血显著相关（P = 0.019；95%置信区间[CI]，1.01 - 1.16），而术中液体输注率未达到统计学显著性（P = 0.06；95% CI，0.99 - 1.28）。在单因素分析中，FTT失败与手术原因显著相关（比值比，5.40；P = 0.03；95% CI，1.69 - 17.3）以及冠状动脉疾病的术前诊断（比值比，3.60；P = 0.03；95% CI，1.16 - 11.2）。术中血管活性药物的使用与FTT并发症或失败率均无关。
FTT并发症与手术失血相关，但与血管活性药物的使用无关。对于接受FTT的患者，审慎监测失血情况可能有助于对并发症和失败风险进行分层。
