2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Research Original Investigation

Anesthesia Duration and Head and Neck Microvascular Reconstruction Complications

Table 1. Preoperative Demographics and Comorbidities Stratified by Anesthesia Cohort a Preoperative Variable

Group 1 (n = 126) Group 2 (n = 125) Group 3 (n = 128) Group 4 (n = 125) Group 5 (n = 126) P Value

Age, mean (SD), y BMI, mean (SD) b

63.7 (13.2) 25.8 (6.0)

61.7 (14.1) 24.8 (4.7)

62.0 (13.6) 26.3 (5.6)

61.0 (13.5) 26.5 (7.0)

59.5 (14.5) 26.7 (5.9)

.18 .10

Obesity (WHO class 1-3) WHO classification (BMI) 0 (<30.0)

24 (19.1) [−0.5] 13 (10.4) [−3.2] 30 (23.4) [0.9]

27 (21.6) [0.3]

36 (28.8) [2.5]

.007

102 (81.0) 14 (11.1)

112 (89.6)

98 (76.6) 23 (18.0)

98 (78.4) 15 (12.0)

89 (71.2) 25 (20.0)

1 (30.0-34.9) 2 (35.0-39.9)

7 (5.6) 5 (4.0) 1 (0.8)

.08

6 (4.8) 4 (3.2)

5 (3.9) 2 (1.6)

7 (5.6) 5 (4.0)

7 (5.6) 4 (3.2)

3 (>40.0)

Sex

Male

87 (69.0) 39 (31.0)

85 (68.0) 40 (32.0)

84 (65.6) 44 (34.4)

91 (72.8) 34 (27.2)

89 (71.2) 36 (28.8)

.08

Female

Race

White Black Other

75 (89.3)

81 (88.0)

92 (87.6)

96 (81.4) 12 (10.2) 10 (8.5) 4.0 (0.6) 39.3 (4.4) 12 (9.6) 33 (26.4) 13 (10.4) 12 (6.4)

91 (81.3) 15 (13.4)

6 (7.1) 3 (3.6)

4 (4.3) 7 (7.6)

6 (5.7) 7 (6.7)

.30

6 (5.4)

Preoperative albumin, mean (SD), g/dL

4.0 (0.7)

4.0 (0.6) 39.4 (4.8)

4.0 (0.5) 39.4 (5.1)

4.0 (0.5) 39.0 (5.1)

.91 .67

Preoperative hematocrit, mean (SD), % 39.9 (5.1)

Comorbidities Diabetes

10 (7.9) 9 (27.8) 9 (8.6) 10 (14.3) 4 (3.2) 11 (8.7) 1 (0.8) 8 (7.6) 5 (4.8) 52 (41.3)

17 (13.6) 29 (23.2) 10 (8.0) 17 (8.0) 6 (4.8) 9 (7.2) 1 (0.8) 6 (4.8) 5 (4.0) 1 (0.8) 1 (0.8) 3 (2.4) 4 (3.2) 5 (4.0) 1 (0.8) 7 (5.6) 10 (8.0) 12 (9.6) 57 (45.6)

14 (10.9) 32 (25.0) 17 (13.3) 14 (7.0) 2 (1.6) 12 (9.4)

11 (8.7) 38 (30.2) 18 (14.5) 11 (11.1) 3 (2.4) 10 (7.9) 1 (0.8) 6 (4.8) 6 (4.8) 60 (47.6) 2 (1.6) 2 (1.6) 9 (7.1) 5 (4.0) 7 (5.6) 6 (4.8) 9 (7.3) 12 (9.5) 18 (14.3)

.61 .77 .40 .17 .48 .36 .73 .23 .85 .77 .08 .91 .26 .90 .59 .18 .82 .80 .07

Current smoker

Alcohol consumption of >2 drinks/d

Dyspnea

Dependent functional status

2 (1.6) 4 (3.2)

History of COPD

CHF <30 d Previous PCI

0

0

13 (10.2)

5 (4.0) 6 (4.8)

Previous cardiac surgery

9 (7.0)

Hypertension History of TIA

63 (49.2) 5 (3.9) 1 (0.8) 6 (4.7) 3 (2.3) 1 (8.6) 2 (1.6) 6 (4.7) 10 (7.8) 8 (6.2)

57 (45.6) 3 (2.4) 2 (1.6) 3 (2.4) 5 (4.0) 8 (6.4) 3 (2.4) 5 (4.0) 11 (8.8) 6 (4.8)

7 (6.7) 2 (1.9) 4 (3.2) 3 (2.4) 5 (4.8) 1 (1.0) 5 (4.8)

History of stroke

Long-term corticosteroid use

Bleeding disorder Chemotherapy Radiotherapy Prior operation

Open wound or wound infection

15 (11.9) 14 (11.1)

Disseminated cancer

tic shock, and stroke. Rates of overall complications, subse- quent operation, unplanned readmission, andmortalitywere also included in this analysis. All statistical analyses were performed using SPSS statis- tical software, version 22 (IBM Inc). Independent 2-tailed, un- paired t test, cross-tabulation, Pearsonχ 2 , andFisher exact tests were used to analyze associations among variables when ap- propriate. Adjusted residuals were calculated for select pre- operative and operative variables and postoperative compli- Abbreviations: BMI, body mass index; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; PCI, percutaneous coronary intervention; TIA, transient ischemic attack; WHO, World Health Organization. SI conversion factors: To convert albumin to grams per liter, multiply by 10; hematocrit to a proportion of 1.0, multiply by 0.01. a Groups 1 through 5 are based on mean (SD) anesthesia times: group 1, 358.1 (175.6) minutes; group 2, 563.2 (27.3) minutes; group 3, 648.9 (24.0) minutes;

cations in the χ 2 analyses. Residuals less than−1.96 and greater than 1.96 were considered to be significant. Preoperative and operative variables found to be significant in the bivariate analysis, as well as basic demographic variables, were in- cluded in multivariable logistic regression models to deter- mine the independent association of increased anesthesia duration with complications after free flap surgery of the head and neck. P < .05 was considered to be statistically significant. group 4, 736.5 (26.3) minutes; and group 5, 922.1 (128.1) minutes. Data are presented as number (percentage) of patients unless otherwise indicated. The χ 2 adjusted residuals are reported in brackets for statistically significant variables with significant residuals greater than 1.96. b Calculated as weight in kilograms divided by height in meters squared. Body mass index is available for 629 of 630 patients; 1 patient is unknown in group 5.

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