Rates of ICU Delirium After Microvascular Free Tissue Transfer Reconstruction of the Oral Cavity and Oropharynx

Microvascular free tissue transfer (MFTT) is the standard in the reconstruction of major head and neck defects, but involves extended hospital stays and an increased risk of post-operative delirium (POD). What risk factors increase the risk of POD in patients undergoing MFTT, and subsequent complications?

Retrospective cohort study of 168 patients undergoing MFTT following ablation of oral cavity or oropharyngeal cancer. Patient demographic data, operative data, post-operative ventilatory support needs, post-operative complications, and post-operative sedation and analgesic needs were collected, and the association with POD was evaluated.

POD was significantly associated with opioid (p = 0.0018) and sedation requirements (p < 0.001), postoperative return to the OR (p = 0.002) and medical complications (p = 0.033). There was no association with the rate of MFTT failure (p > 0.05).

In MFTT patients, opioid and sedative administration are potentially modifiable factors that may be able to reduce POD incidence and optimize the postoperative course of patients undergoing MFTT.