Liver Disease Predicts 30-Day Postoperative Complications in Head and Neck Microvascular Surgery

To investigate the association between liver disease and postoperative outcomes of head and neck microvascular free tissue transfer (MFTT) surgeries.

This retrospective cohort study queried the 2005 to 2021 American College of Surgeons National Surgical Quality Improvement Program databases. Reconstructive cases performed by otolaryngologists (CPT: 15756, 15757, 15758, 15842, 20955, 20956, 20957, 20962, 20969, 20970, 20972, 20973, 43116, 43496, 49006, and 49906) with available age values and preoperative laboratory data were included. Liver disease severity was assessed using the AST-to-platelet ratio index (APRI), a marker of liver fibrosis, and the Model for End-Stage Liver Disease-Sodium (MELD-Na), which predicts mortality. Mild liver disease (MLD) was classified as an APRI score ≥ 0.7 and a MELD-Na score < 10. Advanced liver disease (ALD) was defined as an APRI score ≥ 0.7 and a MELD-Na score ≥ 10. Univariate and multivariable logistic regression were performed.

A total of 5459 cases met the inclusion criteria, of which 93 (1.7%) had mild liver disease, and 105 (1.9%) had advanced liver disease. Adjusted multivariable logistic regression showed that ALD was associated with a significantly higher risk of postoperative complications (OR = 1.62, p = 0.03), medical complications (OR = 2.05, p < 0.01), and return to the operating room within 30 days (OR = 1.87, p = 0.01). ALD patients also experienced prolonged hospital stays and a higher incidence of pneumonia, unplanned intubation, and acute renal failure.

ALD is correlated with increased postoperative complication risks in MFTT surgeries. This study suggests that preoperative liver function assessment and optimization may mitigate surgical risks.