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Liver Disease Predicts 30-Day Postoperative Complications in Head and Neck Microvascular Surgery
Anish R Kosanam1,2, James R Xu1,2, Khashayar Arianpour2
1School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Objective:
To investigate the association between liver disease and postoperative outcomes of head and neck microvascular free tissue transfer (MFTT) surgeries.
Methods:
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.
Results:
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.
Conclusion:
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.
Insights
Advanced liver disease significantly increases complication risks for head and neck microvascular free tissue transfer (MFTT) surgeries. Preoperative liver function assessment and optimization are recommended to mitigate these surgical risks.
Area of Science:
- Reconstructive surgery
- Hepatology
- Surgical outcomes
Background:
- Head and neck microvascular free tissue transfer (MFTT) surgeries are complex procedures.
- The impact of liver disease on postoperative outcomes in MFTT is not well-defined.
Purpose of the Study:
- To investigate the association between liver disease severity and postoperative outcomes in head and neck MFTT surgeries.
- To identify specific complications linked to liver disease in these patients.
Main Methods:
- Retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2005-2021).
- Liver disease severity assessed using AST-to-platelet ratio index (APRI) and Model for End-Stage Liver Disease-Sodium (MELD-Na) scores.
- Mild liver disease (MLD) and advanced liver disease (ALD) were defined based on APRI and MELD-Na thresholds.
Main Results:
- Advanced liver disease (ALD) was significantly associated with higher risks of overall postoperative complications (OR=1.62, p=0.03), medical complications (OR=2.05, p<0.01), and return to the operating room (OR=1.87, p=0.01).
- ALD patients experienced longer hospital stays and increased rates of pneumonia, unplanned intubation, and acute renal failure.
- Mild liver disease (MLD) did not show a statistically significant association with increased complications in this cohort.
Conclusions:
- Advanced liver disease is a significant risk factor for adverse postoperative outcomes in head and neck MFTT surgeries.
- Preoperative assessment and optimization of liver function may be crucial for improving patient safety and surgical success in MFTT.
- Further research into specific interventions for optimizing liver function pre-MFTT is warranted.
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