Postoperative Use of Vasopressors in Head and Neck Microvascular Reconstruction

Abstract

Objectives: Microvascular free tissue reconstruction is overall successful in the treatment of patients with disfiguring wounds resulting from ablative cancer resection, trauma, and osteo(radio)necrosis. Flap failure can be devastating for patients and health care providers. The use of sympathomimetic drugs (vasopressors) in microvascular surgery is controversial; however, current research fails to demonstrate adverse outcomes when intraoperative vasopressors are used. Conversely, intraoperative fluid administration greater than 7 L has been associated with major postoperative complications. The aims of the study were: (1) determine the efficacy of postoperative vasopressor use in free flap patients; (2) compare length of hospital stay in patients who receive vasopressors postoperatively and those who do not. Methods: In this retrospective pilot study, we investigated the use of a postoperative hypotension treatment protocol at our institution, implemented in June 2013. Thirty-nine patients underwent free flap reconstruction of the head and neck secondary to malignancy. Outcome measures included flap viability and length of hospital stay. Results: Analysis of this ongoing study reveals that 23% of patients received peripherally-active vasopressors within the first 3 postoperative days. There were no flap failures in either group. We found no statistically significant difference in the rate of surgical reexploration in patients who received vasopressors postoperatively compared to patients who did not (Fisher’s exact test, P value .12). Conclusions: The length of hospital stay is not statistically significantly different when vasopressors are used postoperatively. The implementation of a formalized hypotension treatment protocol in the postoperative setting does not adversely affect the outcome of free flap survival or length of hospital stay.