Abstract
ObjectivesThe aim of this study was to determine the influence of perioperative fluid management and administration of vasopressors on early surgical revision and flap-related complications in free tissue transfer.Materials and methodsIntraoperative amount of fluid and of vasopressors, relevant perioperative parameters, and comorbidities were recorded in 131 patients undergoing head and neck microvascular reconstruction and compared with early surgical complications, defined as interventions requiring surgery after a flap-related complication, and/or other surgical problems in the operating room within 30 days after initial surgery. The relationship between perioperative variables for each revision category was determined using an optimized multiple logistic regression.ResultsThe administration of diuretics (p=0.001) as a treatment for perioperative fluid overload and the type of flap (p=0.019) was associated with a higher risk of early surgical revisions. Perioperative fluid overload (p=0.039) is significantly related to flap-related complications. We found no effect of intraoperative administration of vasopressors on early surgical revisions (p=0.8) or on flap-related complications (norepinephrine p=0.6, dobutamine p=0.5).ConclusionPerioperative fluid overload is associated with higher risks of early surgical revision and flap-related complications. In contrast, the administration of vasopressors seemed to have no effect on either surgical revision rate or flap-related complications.Clinical relevanceIn patients receiving microvascular reconstructions, a balanced fluid administration perioperatively and a targeted use of vasopressors should be the necessary strategy to reduce the complication rates in head and neck surgery.
Highlights
Microvascular free tissue transfer is established in the head and neck area as a safe and reliable technique for reconstructing a large defect after extensive resection [1]
Anesthesiologists face the difficult task of maintaining hemodynamic stability and tissue perfusion using crystalloids or colloids and the continuous i.v. administration of vasopressors or inotropes
The logistic regression model selected by the backstepping algorithm did not include the confounders “age” and “sex.” We show marginal effect plots for the final regression models to highlight the impact of each predictor on the outcome: to compute these plots, the values of a particular can vary while the other predictors are held constant and the predicted probabilities of the outcome can be graphically displayed
Summary
Microvascular free tissue transfer is established in the head and neck area as a safe and reliable technique for reconstructing a large defect after extensive resection [1]. Head and neck surgery involving free tissue transfer is complex and extensive and associated with an increased risk of complications related to high patient morbidity, resulting to prolonged hospital stays and higher costs [1,2,3]. The amount of fluid administered intraoperatively has been identified as an important predictor of poor results in free tissue transfer surgery, Clin Oral Invest (2021) 25:5541–5550 associated with a higher incidence of local and systemic complications [4,5,6,7,8,9,10]. There is considerable reluctance to use vasopressors due to hypothetical concerns about reduced graft perfusion during or after surgery, which creates additional limitations for anesthesiologists searching for evidence-based options for blood pressure control [11]
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