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Published on: November 8, 2019
Cardiovascular complications in head & neck microvascular flap reconstruction: A retrospective risk stratification
Naseem Ghazali1, Steven Caldroney1, Donita Dyalram1
1Department of Oral & Maxillofacial Surgery, University of Maryland, 650 West Baltimore Street, Baltimore, MD 21201, USA.
Insights
Cardiac complications are uncommon in head and neck microvascular flap surgery. The Revised Cardiac Risk Index (RCRI) helps predict risk, improving patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Surgical Oncology
- Plastic Surgery
Background:
- Assessing cardiac complications (CC) is crucial in head and neck microvascular reconstruction.
- Understanding predictors of CC can optimize patient selection and perioperative management.
Purpose of the Study:
- To determine the incidence of cardiac complications (CC) in head and neck microvascular flap reconstruction.
- To identify predictors of CC in this patient population.
Main Methods:
- Retrospective analysis of 216 microvascular flaps (2012-2015).
- Utilized Revised Cardiac Risk Index (RCRI) and Charlson Comorbidity Index (CCI).
- Multivariate regression analysis identified predictive factors for CC.
Main Results:
- CC occurred in 9.7% of patients; transient arrhythmia (6.5%) and myocardial infarction (2.8%) were most common.
- Univariate analysis showed significant differences in age, smoking, PVD, CCI, RCRI, hospitalization, and anesthesia duration.
- Multivariate analysis identified RCRI (p < 0.001) and blood transfusion (p = 0.02) as independent predictors of CC.
Conclusions:
- Cardiac complications are infrequent in head and neck microvascular flap surgery.
- The RCRI serves as a valuable screening tool for estimating CC risk.
- Utilizing RCRI can enhance patient and flap outcomes.
Background:
To determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction.
Methods:
A series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson Comorbidity Index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes.
Results:
Twenty patients developed CC (9.7%) with transient cardiac arrhythmia (6.5%) and myocardial infarction (2.8%) occurring most frequently. Univariate analyses demonstrated significant differences between the two groups in terms of their age, smoking status, occurrence of peripheral vascular disease, CCI, RCRI, length of hospitalization and duration of anesthesia. Multivariate analyses showed that RCRI (p < 0.001) and amount of blood transfused (p = 0.02) were independent predictors of CC.
Conclusions:
Cardiac complications are uncommon in head and neck microvascular flap surgery. The RCRI is a useful screening tool for estimating cardiac complication risk and improving patient and flap outcomes.
