Complication Rates Associated With Evolving Practice Patterns in Vasopressor Use and Fluid Administration for Oral...

The safety of vasopressors for managing intraoperative hypotension remains debated. This study evaluated complications associated with vasopressor use and fluid administration in oral cavity cancer free flap surgery.

Retrospective review of 826 patients who received oral cavity cancer free flap reconstruction from 2008 to 2019. Inverse probability of treatment weighting controlled for confounding when assessing flap and medical complications.

Vasopressor use increased significantly after 2012 (69.7% to 81.7%) and was not associated with medical (OR 1.36, 95% CI 0.76-2.43) or flap complications (OR 2.24, 95% CI 0.66-7.57). However, higher intraoperative fluid volume was associated with increased risk of medical (OR 1.33 per liter, 95% CI 1.17-1.52) and flap complications (OR 1.30 per liter, 95% CI 1.06-1.59).

Vasopressor use may be favorable over high fluid administration for reducing medical complications. However, low event rates limit statistical power to exclude increased risk of flap complications.