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 3. Postoperative Complications Stratified by Anesthesia Cohort a 30-Day Postoperative Variable Group 1 (n = 126) Group 2 (n = 125)

Group 3 (n = 128)

Group 4 (n = 125)

Group 5 (n = 126)

P Value

Overall complications Surgical complications Superficial SSI

55 (43.7) [−2.8]

60 (48.0) [−1.7]

75 (58.6) [1.0]

75 (60) [1.3]

80 (63.5) [2.2]

.006

10 (7.9) 1 (0.8)

14 (11.2)

7 (5.5) 7 (5.5) 3 (2.3)

6 (4.8) 5 (4.0)

13 (10.3)

.24 .29 .08 .02 .82

Deep incisional SSI Organ or space SSI Wound disruption

3 (2.4)

5 (4.0) 1 (0.8)

0

0

0

0 [−2.6] 8 (6.3)

4 (3.2) [−0.6]

4 (3.1) [−0.6]

8 (6.4) [1.4]

10 (7.9) [2.4]

Flap failure

7 (5.6)

6 (4.7)

5 (4.0)

9 (7.1)

Transfusion within 24 h 32 (25.4) [−4.3]

44 (35.2) [−1.8] 53 (42.4) [−2.0]

61 (47.7) [1.4] 71 (55.5) [1.3]

59 (47.2) [1.3] 71 (56.8) [1.6]

70 (55.6) [3.4] 78 (61.9) [2.9]

<.001 <.001

Total

45 (35.7) [−3.7]

Medical complications Pneumonia

9 (7.1)

7 (5.6) 2 (1.6) 0 [−1.2] 7 (5.6)

8 (6.2) 3 (3.1)

8 (6.4) 2 (1.6) 0 [−1.2]

6 (4.8) 7 (5.6) 0 [−1.2] 8 (6.3)

.95 .20 .03 .93

Unplanned reintubation 7 (5.6) Pulmonary embolism 4 (3.2) [2.9]

2 (1.6) [0.8]

Mechanical ventilation >48 h

8 (6.3)

7 (5.5)

5 (4.)

Renal insufficiency Acute renal failure

0 0

0 0

0 0

0 0 0 0 0

1 (0.8)

.40

0

NA

UTI

3 (2.4)

2 (1.6)

2 (1.6)

1 (0.8)

.51

Coma >24 h

0 0 0

0 0

0 0

0 0

NA NA

Peripheral nerve injury

Cardiac arrest

2 (1.6) 1 (0.8) 4 (3.2) 6 (4.8) 1 (0.8)

1 (0.8) 3 (2.3) 1 (0.8) 6 (4.7) 1 (0.8)

2 (1.6)

2 (1.6) 3 (2.4)

.67 .35 .15 .61 .74 .55 .80 .31 .47 .03

Myocardial infarction

1 (0.8) 1 (0.8) 4 (3.2)

0

DVT

1 (0.8) 2 (1.6)

0

Sepsis

6 (4.8) 1 (0.8) 1 (0.8)

Septic shock

0 0

0

Stroke

0

0

1 (0.8)

Total

24 (19.0) 20 (19.6)

19 (15.2) 1 (13.1)

20 (15.6)

17 (13.6) 16 (17.8) 10 (12.0) 0 [−1.7]

22 (17.5) 15 (19.0) 8 (10.7)

Subsequent operation b

9 (9.9) 5 (5.6)

Readmitted c

6 (6.1)

7 (8.8)

Mortality

1 (0.8) [−0.9]

6 (4.8) [2.9]

3 (2.3) [0.6]

1 (0.8) [−0.9]

group 5. Cases that involved a single nonosseous free flap op- erationwere associatedwith a negatively linear decrease in an- esthesia duration (98 [77.8%] in group 1 vs 68 [54.0%] in group 5; P < .001), with adjusted residual values most significant in group 1. Patients in whommultiple free flap operations were performed were most likely to fall into the top quintile with the longest duration of anesthesia (6 [4.8%] in group 1 vs 19 [15.1%] ingroup5; P = .003),withadjusted residual valuesmost significant in group 5. Postoperative Complications The rate of postoperative transfusion within 48 hours was greatest in group 5 (70 [55.6%]) and lowest in group 1 (32 [25.4%]), and this trend was positively linear across quin- tiles, with adjusted residual values most significantly posi- tive in group 5. The χ 2 analysis demonstrated that this differ- Abbreviations: DVT, deep vein thrombosis; NA, not applicable; SSI, surgical site infections; UTI, urinary tract infection. 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; 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 Data missing for 184 patients (data available for 102 patients in group 1, 84 in group 2, 91 in group 3, 90 in group 4, and 79 in group 5). c Data missing for 204 patients (data available for 98 patients in group 1, 80 in group 2, 90 in group 3, 83 in group 4, and 75 in group 5).

ence in the rates of postoperative transfusion across cohorts was significant ( P < .001) (Table 3). In addition, the rate of wound disruption was significantly distributed across quin- tiles, with a positively linear trend occurring in 10 (7.9%) in group 5 and 0 in group 1 ( P = .02) and adjusted residual val- uesmost significantly positive in group 5 (Table 3). Overall sur- gical complications were also significantly associatedwith in- creased anesthesia duration and demonstrated a positively linear trend, occurring in 45 patients (35.7%) in group 1 and 78 (61.9%) in group 5 ( P < .001) and adjusted residual valuesmost significantly positive in group 5 (Table 3). Distribution of rates of postoperative pulmonary embolismacross cohortswas also significant; however, rates were greatest in group 1 (4 [3.2%]) and uniformly 0 in groups 2, 4, and 5 ( P = .03). Group 3 had pulmonary embolism in 2 patients (1.6%) (Table 3). No other individual medical complications were significantly associ-

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