Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
JAMA Otolaryngol Head Neck Surg. 2024 Feb 1;150(2):127-132. doi: 10.1001/jamaoto.2023.4024.
Despite the widespread use of fibula free flap (FFF) surgery for head and neck reconstruction, there are no studies assessing if early weight-bearing (EWB) affects postoperative recovery, and the timing of weight-bearing initiation following FFF surgery varies considerably across institutions. Therefore, it is important to understand the effect of EWB in these patients and whether it could improve postoperative recovery.
To assess the association of EWB after FFF surgery with donor-site complications, length of stay, and discharge to home status.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study took place at Massachusetts Eye and Ear, a single tertiary care institution in Boston, Massachusetts. A total of 152 patients who received head and neck reconstruction with a fibula osteocutaneous free flap between January 11, 2010, and August 11, 2022, were included.
EWB on postoperative day 1 vs non-EWB on postoperative day 2 or later.
Patient characteristics, including demographic characteristics and comorbidities, surgical characteristics, donor-site complications, length of stay, and discharge disposition, were recorded. Descriptive statistics and multivariate logistic regressions were used to compute effect sizes and 95% CIs to compare postoperative outcomes in EWB and non-EWB groups.
A total of 152 patients (median [IQR] age, 63 [55-70] years; 89 [58.6%] male) were included. The median (IQR) time to postoperative weight-bearing was 3 (1-5) days. Among all patients, 14 (9.2%) had donor-site complications. EWB on postoperative day 1 was associated with shorter length of stay (adjusted odds ratio [AOR], 0.10; 95% CI, 0.02-0.60), increased rate of discharge to home (AOR, 7.43; 95% CI, 2.23-24.80), and decreased donor-site complications (AOR, 0.11; 95% CI, 0.01-0.94). Conversely, weight-bearing 3 or more days postoperatively was associated with an increased risk of pneumonia (AOR, 6.82; 95% CI, 1.33-34.99).
In this cohort study, EWB after FFF surgery was associated with shorter length of stay, increased rate of discharge to home, and decreased donor-site complications. These findings support the role of early mobilization to optimize postoperative recovery after FFF surgery.
尽管腓骨游离皮瓣（FFF）手术被广泛用于头颈部重建，但目前尚无研究评估早期负重（EWB）是否会影响术后恢复，而且不同机构之间 FFF 手术后开始负重的时间差异很大。因此，了解这些患者中 EWB 的影响以及它是否可以改善术后恢复非常重要。
评估 FFF 手术后 EWB 与供区并发症、住院时间和出院回家状态的关系。
设计、地点和参与者：这是一项回顾性队列研究，在马萨诸塞州眼耳医院进行，该医院是位于马萨诸塞州波士顿的一家三级保健机构。共纳入 2010 年 1 月 11 日至 2022 年 8 月 11 日期间接受腓骨骨皮瓣头颈部重建的 152 例患者。
术后第 1 天 EWB 与术后第 2 天或以后的非 EWB。
记录患者特征，包括人口统计学特征和合并症、手术特征、供区并发症、住院时间和出院情况。使用描述性统计和多变量逻辑回归计算效应大小和 95%CI，以比较 EWB 和非 EWB 组的术后结局。
共纳入 152 例患者（中位数[IQR]年龄，63[55-70]岁；89[58.6%]为男性）。术后负重的中位（IQR）时间为 3（1-5）天。所有患者中，14 例（9.2%）有供区并发症。术后第 1 天 EWB 与住院时间缩短（调整优势比[OR]，0.10；95%CI，0.02-0.60）、出院回家率增加（OR，7.43；95%CI，2.23-24.80）和供区并发症减少（OR，0.11；95%CI，0.01-0.94）相关。相反，术后 3 天或以上负重与肺炎风险增加相关（OR，6.82；95%CI，1.33-34.99）。
在这项队列研究中，FFF 手术后的 EWB 与住院时间缩短、出院回家率增加和供区并发症减少相关。这些发现支持在 FFF 手术后早期活动以优化术后恢复的作用。
