Abdul-Rahman Nana-Hawwa, Harris Micah K, Bottegal Matthew, Sridharan Shaum, Spector Matthew, Snyderman Carl H
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2025 Sep;173(3):603-612. doi: 10.1002/ohn.1304. Epub 2025 May 23.
Herein, we evaluate the incidence, risk factors, and prognostic implications of postoperative pulmonary complications (PPCs) in head and neck microvascular free flap (MVFF) reconstruction. Current prediction models were assessed, and a head and neck MVFF-specific model is proposed.
Retrospective review of 638 head and neck MVFF cases from August 2019 to May 2024.
Tertiary academic center.
Data were collected via chart review focusing on preoperative, intraoperative, and postoperative risk factors for PPCs within 30 days of surgery.
Grades 2 to 5 PPCs occurred in 27% of patients. Predictors of PPCs in univariate analysis include prolonged surgery (mean: 10.06 ± 2.67 hours, P = .006), estimated blood loss ≥ 200 mL (n = 111, P = .006), advanced tumor stage (III/IV: n = 123, P = .013), hematoma (n = 25, P < .001), and postoperative transfusion (n = 20, P = .037). Tumor stage (odds ratio [OR] 1.29, 95% CI 1.06-1.57, P = .012), surgery duration (OR 1.08, 95% CI 1.01-1.17, P = .031), and hematoma (OR 2.98, 95% CI 1.50-5.94, P = .002) remained significant predictors of grades 2 to 5 PPCs on multivariable analysis. In-hospital mortality was 1.4% (n = 9), and all experienced grade 5 PPCs. The 1-year mortality rate was 13.48 per 100 patients, with significantly lower survival in patients with grades 2 to 5 PPCs (75.6% vs 89.4%). PPC was independently associated with mortality (hazard ratio [HR] 3.94, 95% CI 1.69-9.22, P = .002). Our model (area under the curve [AUC] 0.65) outperformed the ARISCAT (AUC = 0.51) and Gupta scores (AUC = 0.45) in predicting PPCs.
PPCs are common after MVFF, contributing to significant morbidity and mortality. Current models are inadequate, highlighting the need for a tailored model specific to oncologic head and neck surgery.
在此，我们评估头颈部微血管游离皮瓣（MVFF）重建术后肺部并发症（PPCs）的发生率、危险因素及预后意义。对当前的预测模型进行了评估，并提出了一个头颈部MVFF特异性模型。
回顾性分析2019年8月至2024年5月期间638例头颈部MVFF病例。
三级学术中心。
通过病历审查收集数据，重点关注术后30天内PPCs的术前、术中和术后危险因素。
27%的患者发生2至5级PPCs。单因素分析中PPCs的预测因素包括手术时间延长（平均：10.06±2.67小时，P = 0.006）、估计失血量≥200 mL（n = 111，P = 0.006）、肿瘤晚期（III/IV期：n = 123，P = 0.013）、血肿（n = 25，P < 0.001）和术后输血（n = 20，P = 0.037）。多因素分析中，肿瘤分期（比值比[OR] 1.29，95%置信区间1.06 - 1.57，P = 0.012）、手术时长（OR 1.08，95%置信区间1.01 - 1.17，P = 0.031）和血肿（OR 2.98，95%置信区间1.50 - 5.94，P = 0.002）仍然是2至5级PPCs的显著预测因素。住院死亡率为1.4%（n = 9），所有死亡患者均发生5级PPCs。每100例患者的1年死亡率为13.48，2至5级PPCs患者的生存率显著较低（75.6%对89.4%）。PPC与死亡率独立相关（风险比[HR] 3.94，95%置信区间1.69 - 9.22，P = 0.002）。在预测PPCs方面，我们的模型（曲线下面积[AUC] 0.65）优于ARISCAT模型（AUC = 0.51）和古普塔评分（AUC = 0.45）。
MVFF术后PPCs很常见，会导致显著的发病率和死亡率。当前模型并不完善，凸显了需要一个针对头颈部肿瘤手术的定制模型。
