Zhang Yao, Guo Jun, Ren Delong, Liu Tiantian, Wu Yufei, Li Hui, Liu Bing, Zhang Hui
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research, Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, The Fourth Military Medical University, 145 Changle Road, Xi'an, Shaanxi 710032, PR China.
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research, Center for Dental Materials and Advanced Manufacture, Department of Anesthesiology, School of Stomatology, The Fourth Military Medical University, 145 Changle Road, Xi'an, Shaanxi 710032, PR China.
Br J Oral Maxillofac Surg. 2025 Sep;63(7):486-495. doi: 10.1016/j.bjoms.2024.10.240. Epub 2024 Nov 15.
Head and neck surgery with free-flap reconstruction (FFR) is associated with postoperative complications (PCs), which may affect the short and long-term prognosis of patients. This study aimed to propose a new model to predict the risk of PCs after head and neck surgery with FFR. A retrospective analysis was performed on 528 patients undergoing head and neck surgery with FFR between March 2020 and June 2022 in a tertiary head and neck centre. All information assessed included patient characteristics, tumour, laboratory, and surgical and anaesthetic factors. The primary outcome was a composite of severe non-surgical PCs during hospitalisation. All patients were grouped into those with PCs and those without PCs. Based on univariate and multivariate logistic regression analysis, a model to predict the risk of PCs was constructed and validated with bootstrap resampling. The incidence of PCs was 23.30% (123/528). Five predictors of PCs were identified: age, flap size, blood loss, maximum lactic acid value, and type of airway. The model incorporating these variables had moderate predictive discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.74 (95% CI: 0.69 to 0.79) for PCs, and maintained satisfactory calibration performance (Brier score of 0.157). Meanwhile, the model demonstrated satisfactory clinical significance. We propose a new simple PCs prediction model that shows promise for the guiding of perioperative management after head and neck surgery with FFR.
带游离皮瓣重建术（FFR）的头颈外科手术与术后并发症（PCs）相关，这可能会影响患者的短期和长期预后。本研究旨在提出一种新模型，以预测FFR头颈外科手术后PCs的风险。对2020年3月至2022年6月在一家三级头颈中心接受FFR头颈外科手术的528例患者进行了回顾性分析。评估的所有信息包括患者特征、肿瘤、实验室检查以及手术和麻醉因素。主要结局是住院期间严重非手术PCs的综合情况。所有患者被分为发生PCs组和未发生PCs组。基于单因素和多因素逻辑回归分析，构建了一个预测PCs风险的模型，并通过自助重抽样进行验证。PCs的发生率为23.30%（123/528）。确定了PCs的五个预测因素：年龄、皮瓣大小、失血量、最大乳酸值和气道类型。纳入这些变量的模型具有中等预测辨别力，PCs的受试者操作特征曲线（AUC）下面积为0.74（95%CI：0.69至0.79），并保持了令人满意的校准性能（Brier评分为0.157）。同时，该模型具有令人满意的临床意义。我们提出了一种新的简单的PCs预测模型，该模型有望为FFR头颈外科手术后的围手术期管理提供指导。
