Clinical Factors Influencing Postoperative Airway and Nutritional Management After Microvascular Tongue...

Microvascular free flap reconstruction is a standard approach after oncologic tongue resection, but postoperative airway and nutritional support can delay recovery and impair quality of life. Risk factors for prolonged tracheostomy dependence and percutaneous endoscopic gastrostomy (PEG) tube requirement after isolated tongue reconstruction remain poorly defined.

The primary purpose was to identify clinical and surgical predictors of delayed decannulation, defined a priori as decannulation beyond the cohort mean of 4.9 days, following microvascular reconstruction of isolated tongue defects. The secondary purpose was to determine predictors of postoperative PEG tube placement.

This retrospective cohort study was conducted at Charité-Universitätsmedizin Berlin. Adult subjects undergoing autologous microvascular free flap reconstruction for isolated tongue squamous cell carcinoma without bone resection between 2017 and 2024 were included.

The predictor variable was a set of heterogenous risk factors categorized as demographic, clinical, pathologic, and operative variables.

The primary outcome variable was delayed decannulation, measured as days between tracheostomy and successful decannulation. The secondary outcome variable was nutritional management and the need for postoperative PEG tube placement.

Not applicable.

Univariate analyses group comparisons were performed. Cox proportional hazards regression was used to evaluate predictors of time to decannulation, and multivariate logistic regression was used to identify predictors of PEG tube placement. The level of significance was set as P < .05.

A total of 219 subjects (mean age 65.1 years) were included. The mean time to decannulation was 4.9 ± 3.9 days (median (interquartile range): 4 (3 to 6) days). PEG tubes were placed in 16 subjects (7.3%). Bilateral neck dissection independently predicted prolonged decannulation (hazard ratio = 0.58 [0.37; 0.90]; P = .02). PEG tube placement was independently associated with anterolateral thigh flap reconstruction (odds ratio = 7.11 [4.62; 24.59]; P = .004) and bilateral neck dissection (odds ratio = 11.40 [1.44; 31.28]; P = .0002).

Airway and nutritional recovery after microvascular reconstruction of isolated tongue defects achieved early in most subjects, with infrequent PEG requirement. Bilateral neck dissection is the strongest determinant of delayed decannulation and PEG requirement, supporting individualized preoperative counseling and less invasive cervical management where appropriate.