Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
J Craniofac Surg. 2022;33(8):2507-2512. doi: 10.1097/SCS.0000000000008762. Epub 2022 Aug 2.
To find out the occurrence rate and risk factors of unplanned reoperation (any unscheduled surgery within 30 d after the initial surgery) in patients who have received oral squamous cell carcinoma (OSCC) surgery and vascularized free flap reconstruction.
We organized a retrospective study of 1058 patients who underwent OSCC resection and reconstruction with vascularized free flaps from 2011 to 2019. Clinical characteristics, reasons for unplanned reoperation, flap types, and previous treatment were compared between the unplanned reoperation group and the control group. Univariate and multivariate analyses were performed to identify perioperative risk factors for unplanned reoperation. The related perioperative factors that may influence perioperative infusion were included in propensity score matching to investigate the independent contribution of intraoperative colloid infusion on unplanned reoperation.
The overall rate of unplanned reoperation in OSCC patients was 11% (n=115). Flap necrosis and bleeding were the most common causes. Higher American Society of Anesthesiologists (ASA) grade [odds ratio (OR)=1.709, P=0.009], postoperative anemia (OR=0.983, P=0.011) and excessive intraoperative colloid input (OR=1.55, P=0.037) were identified as risk factors for unplanned reoperation. Propensity score matching was applied, and the difference of unplanned reoperation incidence between the matched groups was statistically significant (14.59% versus 8.54%; P=0.025). The multivariate analyses after propensity score matching confirmed that the intraoperative rate of colloid infusion of more than 2.3 mL/kg/h (OR=1.756, P=0.042) and prior radiotherapy (OR=2.78, P=0.001) are independent risk factors for unplanned reoperation.
High intraoperative colloid infusion rate and prior radiotherapy may increase the risk of unplanned reoperation in patients who underwent OSCC surgery and vascularized free flap reconstruction.
确定接受口腔鳞状细胞癌（OSCC）手术和血管化游离皮瓣重建的患者中，计划性再手术（初始手术后 30 天内的任何非计划性手术）的发生率和危险因素。
我们组织了一项回顾性研究，纳入了 2011 年至 2019 年期间接受 OSCC 切除和血管化游离皮瓣重建的 1058 例患者。比较了计划性再手术组和对照组之间的临床特征、计划性再手术的原因、皮瓣类型和既往治疗。进行单因素和多因素分析，以确定计划性再手术的围手术期危险因素。纳入可能影响围手术期输液的相关围手术期因素进行倾向评分匹配，以研究术中胶体输注对计划性再手术的独立影响。
OSCC 患者计划性再手术的总体发生率为 11%（n=115）。皮瓣坏死和出血是最常见的原因。较高的美国麻醉医师协会（ASA）分级（优势比[OR]=1.709，P=0.009）、术后贫血（OR=0.983，P=0.011）和术中胶体输入过多（OR=1.55，P=0.037）被确定为计划性再手术的危险因素。进行了倾向评分匹配，匹配组之间计划性再手术发生率的差异具有统计学意义（14.59%比 8.54%；P=0.025）。倾向评分匹配后的多因素分析证实，术中胶体输入率超过 2.3 mL/kg/h（OR=1.756，P=0.042）和放疗史（OR=2.78，P=0.001）是计划性再手术的独立危险因素。
高术中胶体输注率和放疗史可能会增加接受 OSCC 手术和血管化游离皮瓣重建的患者计划性再手术的风险。
