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Perioperative Risk Prediction in Head and Neck Free Flap Reconstructive Surgery.

Karolina Persson1,2, Madeleine Torén2,3, Louise Walther Sturesson1,2

  • 1Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.

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|September 1, 2025
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Summary
This summary is machine-generated.

Longer surgery times and red blood cell transfusions increase flap compromise risk in head and neck reconstruction. Comorbidity indices like ASA-PS, CCI, and HN-CCI predict systemic complications.

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Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Head and Neck Surgery
  • Reconstructive Surgery

Background:

  • Extensive head and neck reconstructive surgery poses high risks due to patient comorbidities.
  • Preoperative assessment and risk prediction are crucial for optimizing patient outcomes.
  • Anesthesiologists play a vital role in managing perioperative risk.

Purpose of the Study:

  • To evaluate readily available clinical parameters for predicting postoperative complications in head and neck free flap surgery.
  • To identify key factors associated with flap compromise and systemic complications.

Main Methods:

  • Retrospective registry study of 388 patients undergoing head and neck free flap surgery (2009-2022).
  • Logistic regression analyses to associate perioperative variables with outcomes.
  • Included risk scores, lab values, flap type, surgery duration, and fluid/drug administration.

Main Results:

  • Surgery time and red blood cell transfusion were significantly associated with flap compromise (p<0.01).
  • American Society of Anesthesiologists Physical Status (ASA-PS), Charlson Comorbidity Index (CCI), and Head Neck Charlson Comorbidity Index (HN-CCI) predicted systemic complications (p<0.025).

Conclusions:

  • Surgery duration and perioperative red blood cell transfusion strongly predict flap compromise.
  • ASA-PS, CCI, and HN-CCI are independent predictors of systemic complications.
  • HN-CCI is demonstrated as valuable for risk stratification in head and neck reconstruction.