Persson Karolina, Torén Madeleine, Walther Sturesson Louise, Kander Thomas, Nilsson Caroline, Sjövall Johanna
Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.
Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Acta Anaesthesiol Scand. 2025 Oct;69(9):e70115. doi: 10.1111/aas.70115.
Extensive head and neck reconstructive surgery is a complex procedure often performed in patients with multiple comorbidities, and the risk of complications is high. Evidence-based preoperative assessment and reliable risk prediction are therefore essential, and the anesthesiologist plays an important role in this process. The aim of this study was to evaluate the predictive properties of readily available clinical parameters for postoperative complications.
We performed a retrospective registry study including 388 patients undergoing head and neck free flap surgery between 2009 and 2022. Logistic regression analyses were used to establish associations between perioperative variables and postoperative flap compromise and systemic complications during primary in-hospital stay. Perioperative variables included risk prediction instrument scores, biochemical laboratory values, type of flap, surgery time, and fluids and drugs administered.
Factors associated with flap compromise in multivariable analysis were surgery time (p = 0.005) and perioperative red blood cell transfusion (p = 0.001). American Society of Anesthesiologists Physical Status (ASA-PS) (p = 0.012), Charlson Comorbidity Index (CCI) (p = 0.021) and Head Neck Charlson Comorbidity Index (HN-CCI) (p = 0.024) were factors most significantly associated with systemic complications.
Strong association was seen between surgery time and perioperative red blood cell transfusion and flap compromise. ASA-PS, CCI, and its simplified version HN-CCI were shown to be independently associated with systemic complications. To the best of our knowledge, this is the first study demonstrating the value of Head Neck Charlson Comorbidity Index in this setting.
This single center cohort analysis describes factors associated with head and neck free flap surgery postoperative flap compromise and other major complications. Established comorbidity indices were included in the analysis.
广泛的头颈部重建手术是一项复杂的手术，通常在患有多种合并症的患者中进行，并发症风险很高。因此，基于证据的术前评估和可靠的风险预测至关重要，麻醉医生在这一过程中发挥着重要作用。本研究的目的是评估易于获得的临床参数对术后并发症的预测特性。
我们进行了一项回顾性登记研究，纳入了2009年至2022年间接受头颈部游离皮瓣手术的388例患者。采用逻辑回归分析来确定围手术期变量与术后皮瓣受损及初次住院期间全身并发症之间的关联。围手术期变量包括风险预测工具评分、生化实验室值、皮瓣类型、手术时间以及给予的液体和药物。
多变量分析中与皮瓣受损相关的因素为手术时间（p = 0.005）和围手术期红细胞输血（p = 0.001）。美国麻醉医师协会身体状况评分（ASA-PS）（p = 0.012）、查尔森合并症指数（CCI）（p = 0.021）和头颈查尔森合并症指数（HN-CCI）（p = 0.024）是与全身并发症最显著相关的因素。
手术时间和围手术期红细胞输血与皮瓣受损之间存在密切关联。ASA-PS、CCI及其简化版HN-CCI被证明与全身并发症独立相关。据我们所知，这是第一项证明头颈查尔森合并症指数在此情况下价值的研究。
这项单中心队列分析描述了与头颈部游离皮瓣手术术后皮瓣受损及其他主要并发症相关的因素。分析中纳入了既定的合并症指数。
