Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.
Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.
JAMA Facial Plast Surg. 2018 May 1;20(3):188-195. doi: 10.1001/jamafacial.2017.1607.
Prolonged anesthesia and operative times have deleterious effects on surgical outcomes in a variety of procedures. However, data regarding the influence of anesthesia duration on microvascular reconstruction of the head and neck are lacking.
To examine the association of anesthesia duration with complications after microvascular reconstruction of the head and neck.
DESIGN, SETTING, AND PARTICIPANTS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to collect data. In total, 630 patients who underwent head and neck microvascular reconstruction were recorded in the NSQIP registry from January 1, 2005, through December 31, 2013. Patients who underwent microvascular reconstructive surgery performed by otolaryngologists or plastic surgeons were included in this study. Data analysis was performed from October 15, 2015, to January 15, 2016.
Microvascular reconstructive surgery of the head and neck.
Patients were stratified into 5 quintiles based on mean anesthesia duration and analyzed for patient characteristics and operative variables (mean [SD] anesthesia time: group 1, 358.1 [175.6] minutes; group 2, 563.2 [27.3] minutes; group 3, 648.9 [24.0] minutes; group 4, 736.5 [26.3] minutes; and group 5, 922.1 [128.1] minutes). Main outcomes include rates of postoperative medical and surgical complications and mortality.
A total of 630 patients undergoing head and neck free flap surgery had available data on anesthesia duration and were included (mean [SD] age, 61.6 [13.8] years; 436 [69.3%] male). Bivariate analysis revealed that increasing anesthesia duration was associated with increased 30-day complications overall (55 [43.7%] in group 1 vs 80 [63.5%] in group 5, P = .006), increased 30-day postoperative surgical complications overall (45 [35.7%] in group 1 vs 78 [61.9%] in group 5, P < .001), increased rates of postoperative transfusion (32 [25.4%] in group 1 vs 70 [55.6%] in group 5, P < .001), and increased rates of wound disruption (0 in group 1 vs 10 [7.9%] in group 5, P = .02). No specific medical complications and no overall medical complication rate (24 [19.0%] in group 1 vs 22 [17.5%] in group 5, P = .80) or mortality (1 [0.8%] in group 1 vs 1 [0.8%] in group 5, P = .75) were associated with increased anesthesia duration. On multivariate analysis accounting for demographics and significant preoperative factors including free flap type, overall complications (group 5: odds ratio [OR], 1.98; 95% CI, 1.10-3.58; P = .02), surgical complications (group 5: OR, 2.46; 95% CI, 1.35-4.46; P = .003), and postoperative transfusion (group 5: OR, 2.31; 95% CI, 1.27-4.20; P = .006) remained significantly associated with increased anesthesia duration; the association of wound disruption and increased anasthesia duration was nonsignificant (group 5: OR, 2.0; 95% CI, 0.75-5.31; P = .16).
Increasing anesthesia duration was associated with significantly increased rates of surgical complications, especially the requirement for postoperative transfusion. Rates of medical complications were not significantly altered, and overall mortality remained unaffected. Avoidance of excessive blood loss and prolonged anesthesia time should be the goal when performing head and neck free flap surgery.
在各种手术中，长时间的麻醉和手术时间对手术结果有不良影响。然而，关于麻醉持续时间对头颈部微血管重建后并发症的影响的数据尚缺乏。
研究麻醉持续时间与头颈部微血管重建后并发症之间的关联。
设计、地点和参与者：利用美国外科医师学会国家外科质量改进计划（NSQIP）数据库收集数据。共有 630 例接受头颈部微血管重建的患者被记录在 NSQIP 注册中心，时间从 2005 年 1 月 1 日至 2013 年 12 月 31 日。本研究纳入接受耳鼻喉科或整形外科医生进行的微血管重建手术的患者。数据分析于 2015 年 10 月 15 日至 2016 年 1 月 15 日进行。
头颈部微血管重建手术。
根据平均麻醉时间将患者分为 5 个五分位数组进行分析，并分析患者特征和手术变量（平均[标准差]麻醉时间：第 1 组，358.1[175.6]分钟；第 2 组，563.2[27.3]分钟；第 3 组，648.9[24.0]分钟；第 4 组，736.5[26.3]分钟；第 5 组，922.1[128.1]分钟）。主要结局包括术后医疗和手术并发症及死亡率的发生率。
共有 630 例行头颈部游离皮瓣手术的患者有麻醉持续时间的数据，并纳入研究（平均[标准差]年龄，61.6[13.8]岁；男性 436 例[69.3%]）。双变量分析显示，麻醉持续时间的增加与整体 30 天并发症的增加相关（第 1 组 55 例[43.7%]，第 5 组 80 例[63.5%]，P=0.006），整体 30 天术后手术并发症的增加（第 1 组 45 例[35.7%]，第 5 组 78 例[61.9%]，P<0.001），术后输血率的增加（第 1 组 32 例[25.4%]，第 5 组 70 例[55.6%]，P<0.001），以及伤口破裂率的增加（第 1 组 0 例，第 5 组 10 例[7.9%]，P=0.02）。没有特定的医疗并发症，也没有整体医疗并发症发生率（第 1 组 24 例[19.0%]，第 5 组 22 例[17.5%]，P=0.80）或死亡率（第 1 组 1 例[0.8%]，第 5 组 1 例[0.8%]，P=0.75）与麻醉持续时间的增加相关。在多变量分析中，考虑到人口统计学和术前重要因素，包括游离皮瓣类型，整体并发症（第 5 组：比值比[OR]，1.98；95%置信区间[CI]，1.10-3.58；P=0.02）、手术并发症（第 5 组：OR，2.46；95%CI，1.35-4.46；P=0.003）和术后输血（第 5 组：OR，2.31；95%CI，1.27-4.20；P=0.006）仍与麻醉持续时间的增加显著相关；伤口破裂与麻醉持续时间增加的关联无统计学意义（第 5 组：OR，2.0；95%CI，0.75-5.31；P=0.16）。
麻醉持续时间的增加与手术并发症的发生率显著相关，尤其是需要术后输血。医疗并发症的发生率没有显著改变，整体死亡率不受影响。在进行头颈部游离皮瓣手术时，应避免过度失血和长时间麻醉。
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