Abstract
Autologous bone grafts for reconstruction and augmentation are routinely used for maintaining functionality and facial aesthetics. Associated complications, however, have a significant impact on patients and health care systems. This study aims to investigate the possible risk factors associated with the occurrence of complications in order to provide evidence for the outcome of autologous bone graft reconstructive procedures. Patients from 2008 to 2018 who underwent autologous (mostly mandibular) reconstruction were included in the observational study. Clinical, pathological, and therapeutic factors were examined in univariate and multivariate analysis for significance with occurring complications. A multivariate model was used to create a prognostic model predicting the occurrence of complications. Graft complications requiring revision were exhibited by 33/128 patients. Infections were most frequent, with 4/22 patients affected by multi-resistant germs. Multivariate analysis showed radiotherapy (OR = 5.714; 95% CI: 1.839–17.752; p = 0.003), obstructive pulmonary disease (OPD) (OR = 4.329; 95% CI: 1.040–18.021; p = 0.044) and length of defect (in mm) (OR = 1.016; 95% CI: 1.004–1.028; p = 0.009) as independent risk factors associated with graft complications with high accuracy of prediction (AUC = 0.815). Intensive care (OR = 4.419; 95% CI: 1.576–12.388; p = 0.005) with a coefficient between intensive care and OPD (0.214) being low was identified as the most relevant risk factor for infection. Although intensive care is not a classic risk factor, but rather a summation of factors not reaching significance in the individual case, a stay in ICU (intensive care unit) needs to be considered for graft complications. As a clinical consequence, we recommend using the best possible hygienic measures during procedures e.g., while performing dressing and drainage changes in ICU.
Highlights
The integrity of the mandible, which is decisive for the form and functionality of the face and aesthetics, speech, chewing and swallowing process, is at risk from tumor diseases, trauma, osteoradionecrosis, and chronic osteomyelitis
Defect size, radiotherapy and smoking are named as risk factors, with only radiotherapy and smoking recognized as independent risk factors [9,24]
The aim of the present study is to examine whether there is a significant correlation between stays on the intensive care unit and other possible risk factors, such as comorbidities and underlying bone disease with the occurrence of complications after autologous bone grafts
Summary
The integrity of the mandible, which is decisive for the form and functionality of the face and aesthetics, speech, chewing and swallowing process, is at risk from tumor diseases, trauma, osteoradionecrosis, and chronic osteomyelitis. The choice of graft depends on the anatomical location and size of the defect, with fibula grafts being the most used as the current “gold standard” [1,2]. The complication rate for reconstruction and augmentation procedures using autologous bone grafts in craniofacial surgery is reported with a greatly varying range between 10.3 to 69.2% [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18], a re-operation rate of 10.6 to. The correlation between graft failure and complication rate is controversially discussed with the type of graft used [2,20,23]. Defect size, radiotherapy and smoking are named as risk factors, with only radiotherapy and smoking recognized as independent risk factors [9,24]
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