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Factors Associated With Unplanned Return to Theater in Reconstructive Head and Neck Cancer Patients: A Retrospective

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Frailty and bony free flaps increase unplanned return to theater (URTT) after head and neck cancer reconstruction. Identifying these risk factors aids surgical planning and improves patient outcomes.

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Area of Science:

  • Oncology
  • Surgical Reconstruction
  • Patient Safety

Background:

  • Unplanned return to theater (URTT) is a significant challenge in head and neck cancer reconstruction.
  • Identifying URTT risk factors is crucial for surgical planning and patient risk stratification.

Purpose of the Study:

  • To evaluate preoperative and intraoperative factors associated with URTT in patients undergoing free flap reconstruction for head and neck cancer.

Main Methods:

  • Retrospective cohort study of 609 patients undergoing head and neck tumor resection with free flap reconstruction (July 2015 - January 2024).
  • Analysis of demographic, clinical, and operative data using univariable and multivariable logistic regression.

Main Results:

  • 32.7% of patients experienced URTT within 90 days postoperatively.
  • Higher frailty index scores and the use of bony free flaps were independently associated with increased URTT risk.
  • Common URTT indications included infected collections, hematoma, and flap dehiscence.

Conclusions:

  • Frailty and bony free flap use are key predictors of URTT in head and neck cancer reconstruction.
  • These findings support preoperative risk stratification and targeted interventions to reduce URTT and optimize resource utilization.