Factors Influencing the Incidence of Severe Complications in Head and Neck Free Flap Reconstructions.

Détails

Ressource 1Télécharger: gox-4-e1013.pdf (721.49 [Ko])
Etat: Serval
Version: Final published version
ID Serval
serval:BIB_E29AA1EAA562
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Factors Influencing the Incidence of Severe Complications in Head and Neck Free Flap Reconstructions.
Périodique
Plastic and reconstructive surgery. Global open
Auteur(s)
Broome M., Juilland N., Litzistorf Y., Monnier Y., Sandu K., Pasche P., Plinkert P.K., Federspil P.A., Simon C.
ISSN-L
2169-7574
Statut éditorial
Publié
Date de publication
10/2016
Peer-reviewed
Oui
Volume
4
Numéro
10
Pages
e1013
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
Complications after head and neck free-flap reconstructions are detrimental and prolong hospital stay. In an effort to identify related variables in a tertiary regional head and neck unit, the microvascular reconstruction activity over the last 5 years was captured in a database along with patient-, provider-, and volume-outcome-related parameters.
Retrospective cohort study (level of evidence 3), a modified Clavien-Dindo classification, was used to assess severe complications.
A database of 217 patients was created with consecutively reconstructed patients from 2009 to 2014. In the univariate analysis of severe complications, we found significant associations (P < 0.05) between type of flap used, American Society of Anesthesiologists classification, T-stage, microscope use, surgeon, flap frequency, and surgeon volume. Within a binomial logistic regression model, less frequently versus frequently performed flap (odds ratio [OR] = 3.2; confidence interval [CI] = 2.9-3.5; P = 0.000), high-volume versus low-volume surgeon (OR = 0.52; CI = -0.22 to 0.82; P = 0.007), and ASA classification (OR = 2.9; CI = 2.4-3.4; P = 0.033) were retained as independent predictors of severe complications. In a Cox-regression model, surgeon (P = 0.011), site of reconstruction (P = 0.000), T-stage (P = 0.001), and presence of severe complications (P = 0.015) correlated with a prolonged hospitalization.
In this study, we identified a correlation of patient-related factors with severe complications (ASA score) and prolonged hospital stay (T-stage, site). More importantly, we identified several provider- (surgeon) and volume-related (frequency with which a flap was performed and high-volume surgeon) factors as predictors of severe complications. Our data indicate that provider- and volume-related parameters play an important role in the outcome of microvascular free-flap procedures in the head and neck region.

Pubmed
Création de la notice
09/12/2016 11:54
Dernière modification de la notice
03/03/2018 22:10
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