Perioperative Risk Prediction in Head and Neck Free Flap Reconstructive Surgery

Extensive head and neck reconstructive surgery is a complex procedure often performed in patients with multiple comorbidities, and the risk of complications is high. Evidence-based preoperative assessment and reliable risk prediction are therefore essential, and the anesthesiologist plays an important role in this process. The aim of this study was to evaluate the predictive properties of readily available clinical parameters for postoperative complications.

We performed a retrospective registry study including 388 patients undergoing head and neck free flap surgery between 2009 and 2022. Logistic regression analyses were used to establish associations between perioperative variables and postoperative flap compromise and systemic complications during primary in-hospital stay. Perioperative variables included risk prediction instrument scores, biochemical laboratory values, type of flap, surgery time, and fluids and drugs administered.

Factors associated with flap compromise in multivariable analysis were surgery time (p = 0.005) and perioperative red blood cell transfusion (p = 0.001). American Society of Anesthesiologists Physical Status (ASA-PS) (p = 0.012), Charlson Comorbidity Index (CCI) (p = 0.021) and Head Neck Charlson Comorbidity Index (HN-CCI) (p = 0.024) were factors most significantly associated with systemic complications.

Strong association was seen between surgery time and perioperative red blood cell transfusion and flap compromise. ASA-PS, CCI, and its simplified version HN-CCI were shown to be independently associated with systemic complications. To the best of our knowledge, this is the first study demonstrating the value of Head Neck Charlson Comorbidity Index in this setting.

This single center cohort analysis describes factors associated with head and neck free flap surgery postoperative flap compromise and other major complications. Established comorbidity indices were included in the analysis.