Ettinger Kyle S, Arce Kevin, Lohse Christine M, Peck Brandon W, Reiland Matthew D, Bezak Brett J, Moore Eric J
Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
Division of Biostatistics & Informatics, Mayo Clinic, Rochester, MN.
Microsurgery. 2017 Feb;37(2):128-136. doi: 10.1002/micr.30061. Epub 2016 Apr 21.
The purpose of this study is to evaluate the impact of perioperative fluid administration on the rates of postoperative complications following head and neck reconstruction with fibular free flaps (FFF).
A retrospective cohort study of subjects undergoing head and neck reconstruction with FFF was completed. The primary predictor variable was the total volume of perioperative fluids administered on the day of surgery. The primary outcome variable was the presence of medical and surgical complications occurring within 30 days of surgery. Medical and surgical complications were stratified as major or minor based on severity level. Basic demographic information, comorbidity indices, and intraoperative parameters were abstracted as covariates. Univariable and multivariable models were developed to assess for associations between total fluid volume administered on the day of surgery and postoperative medical/surgical complications occurring within 30 days of surgery.
In 154 subjects, the partial flap failure rate was 3% and there were no complete flap failures. Total fluid volume was significantly associated with the presence of postoperative medical/surgical complications (OR = 1.21; 95% CI: 1.02-1.44; p = 0.032). A cutpoint for total fluid volume predicting any severity level of postoperative complication was identified at 5,500 mL. A cutpoint for total fluid volume predicting major postoperative complications was identified at 7,000 mL.
The results of this study suggest that liberal fluid administration is associated with increased rates of medical/surgical complications following head and neck reconstruction with FFF. © 2016 Wiley Periodicals, Inc. Microsurgery 37:128-136, 2017.
本研究旨在评估围手术期液体输注对游离腓骨瓣（FFF）头颈部重建术后并发症发生率的影响。
完成了一项对接受FFF头颈部重建患者的回顾性队列研究。主要预测变量是手术当天围手术期输注的液体总量。主要结局变量是术后30天内发生的内科和外科并发症。内科和外科并发症根据严重程度分为严重或轻微。提取基本人口统计学信息、合并症指数和术中参数作为协变量。建立单变量和多变量模型，以评估手术当天输注的总液体量与术后30天内发生的内科/外科并发症之间的关联。
154例患者中，部分皮瓣失败率为3%，无完全皮瓣失败。总液体量与术后内科/外科并发症的发生显著相关（OR = 1.21；95% CI：1.02 - 1.44；p = 0.032）。预测任何严重程度术后并发症的总液体量切点为5500 mL。预测严重术后并发症的总液体量切点为7000 mL。
本研究结果表明，在FFF头颈部重建术后大量输注液体与内科/外科并发症发生率增加有关。© 2016威利期刊公司。显微外科学37:128 - 136，2017。
