Jason L Kass1, Sameer Lakha2, Matthew A Levin2, Thomas Joseph3, Hung-Mo Lin4, Eric M Genden5, Marita S Teng5, Brett A Miles5, Samuel DeMaria2. 1. Department of Otolaryngology - Head and Neck Surgery, Dana Farber Cancer Institute, Boston, Massachusetts. 2. Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 4. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. 5. Department of Otolaryngology Head and Neck Surgery, Division of Head and Neck Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
BACKGROUND: In free flap head and neck reconstructions, hemodynamic management is complicated by the deleterious effects of excessive crystalloid administration. Patients may undergo periods of hypotension or excess fluid administration. The purpose of this study was to present our examination of the hypotheses that intraoperative hypotension and blood pressure lability are associated with increased fluid administration and flap failure. METHODS: We reviewed the records of 445 patients undergoing head and neck surgery involving free tissue transfer. We used multivariate logistic regression to examine the relationship between hemodynamic variables and flap loss (primary outcome) and other complications. RESULTS: On multivariate analysis, intraoperative hypotension and large-volume fluid administration were associated with flap loss. Neither blood pressure lability nor vasopressor administration was significantly associated to our primary outcome. CONCLUSIONS: Intraoperative hypotension is associated to flap failure in head and neck free tissue transfer surgeries, as is large-volume fluid administration.
BACKGROUND: In free flap head and neck reconstructions, hemodynamic management is complicated by the deleterious effects of excessive crystalloid administration. Patients may undergo periods of hypotension or excess fluid administration. The purpose of this study was to present our examination of the hypotheses that intraoperative hypotension and blood pressure lability are associated with increased fluid administration and flap failure. METHODS: We reviewed the records of 445 patients undergoing head and neck surgery involving free tissue transfer. We used multivariate logistic regression to examine the relationship between hemodynamic variables and flap loss (primary outcome) and other complications. RESULTS: On multivariate analysis, intraoperative hypotension and large-volume fluid administration were associated with flap loss. Neither blood pressure lability nor vasopressor administration was significantly associated to our primary outcome. CONCLUSIONS:Intraoperative hypotension is associated to flap failure in head and neck free tissue transfer surgeries, as is large-volume fluid administration.
Authors: John-Patrik Burkhard; Jelena Pfister; Roland Giger; Markus Huber; Claudia Lädrach; Manuel Waser; Radu Olariu; Dominique Engel; Lukas M Löffel; Benoît Schaller; Patrick Y Wuethrich Journal: Clin Oral Investig Date: 2021-03-08 Impact factor: 3.573