Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong District, Kaohsiung, 83301, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Eur Arch Otorhinolaryngol. 2024 Sep;281(9):4983-4990. doi: 10.1007/s00405-024-08727-5. Epub 2024 May 17.
Few studies have examined the preoperative risks and healthcare costs related to free flap revision in hypopharyngeal cancer (HPC) patients.
A 20-year retrospective case-control study was conducted using the Chang Gung Research Database, focusing on HPC patients who underwent tumor excision and free flap reconstruction from January 1, 2001, to December 31, 2019. The impacts of clinical variables on the need for re-exploration due to free flap complications were assessed using logistic regression. The direct and indirect effects of these complications on medical costs were evaluated by causal mediation analysis.
Among 348 patients studied, 43 (12.4%) developed complications requiring re-exploration. Lower preoperative albumin levels significantly increased the risk of complications (OR 2.45, 95% CI 1.12-5.35), especially in older and previously irradiated patients. Causal mediation analysis revealed that these complications explained 11.4% of the effect on increased hospitalization costs, after controlling for confounders.
Lower preoperative albumin levels in HPC patients are associated with a higher risk of microvascular free flap complications and elevated healthcare costs, underscoring the need for enhanced nutritional support before surgery in this population.
鲜有研究探讨下咽癌（HPC）患者游离皮瓣修复术的术前风险和医疗保健成本。
采用长庚研究数据库进行了一项为期 20 年的回顾性病例对照研究，纳入 2001 年 1 月 1 日至 2019 年 12 月 31 日期间因 HPC 接受肿瘤切除和游离皮瓣重建的患者。采用逻辑回归评估临床变量对游离皮瓣并发症导致再次探查的影响。采用因果中介分析评估这些并发症对医疗费用的直接和间接影响。
在 348 名研究患者中，有 43 名（12.4%）出现需要再次探查的并发症。术前白蛋白水平较低显著增加了并发症的风险（OR 2.45，95%CI 1.12-5.35），尤其是在老年和既往放疗的患者中。在控制混杂因素后，因果中介分析显示，这些并发症解释了住院费用增加的 11.4%的影响。
HPC 患者术前白蛋白水平较低与微血管游离皮瓣并发症风险增加和医疗保健成本升高相关，强调了此类患者术前加强营养支持的必要性。
