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American Association of Plastic Surgeons
15. Postoperative Medical Complications Not Microsurgical Complications Negatively Influence The Morbidity, Mortality And True Costs After Microsurgical Reconstruction For Head And Neck Cancer
Neil F. Jones, MD, Bernard M. Markowitz, MD.
UCLA, Los Angeles, CA, USA.

PURPOSE: A retrospective analysis of the last consecutive 100 patients undergoing immediate microsurgical reconstruction for head and neck cancer was performed, to determine whether microsurgical complications or postoperative medical complications had the more profound influence on the morbidity and mortality outcomes and true costs of these microsurgical reconstructions.
METHODS: A retrospective chart review of 97 patients with head and neck tumors and 3 patients with osteoradionecrosis of the mandible focused on the patient's age, diagnosis and stage of disease, ASA classification, previous radiation, total operative time, surgical and medical complications and mortality. True hospital cost factors of intensive care, ventilatory support and hospital stay were analyzed. Quality of life parameters including time to tracheostomy decannulation, time to oral feeding and discharge disposition were also compared.
RESULTS: 6 patients developed a major surgical complication requiring a second operative intervention, including 2 patients who required re-exploration of the microsurgical anastomoses (2%) and 3 patients who required re-exploration for bleeding (3%). One flap failed completely (1%). 16% developed minor surgical complications related to the donor site. Major medical complications defined as a major threat to the patient's life (stroke, myocardial infarction, renal failure, gastrointestinal bleeding) occurred in 5% of patients, but there was a significant 36% incidence of minor medical complications, primarily related to pulmonary infections, prolonged ventilatory support and alcohol withdrawal. The average ICU stay was 3.8 days and patients were ventilator dependent for 1.2 days.Tracheostomies were decannulated a mean of 11.9 days postoperatively and patients were able to resume an oral diet an average of 10.2 days postoperatively. The mean hospital stay was 16.2 days and 83% of patients were discharged home, but 17% were transferred to a convalescent care facility. The peri-operative mortality was 1%. Patient's age, previous radiation and total operative time had no effect on the microsurgical complications. Previous radiation and elevated ASA rating were statistically significant predictors of medical complications. The true hospital resource costs of those patients developing a complication increased 70.6%.
CONCLUSIONS: Immediate microsurgical reconstruction after head and neck cancer is now close to 100% successful with reexploration rates of 2% and failure rates of 1%. Postoperative medical complications related to pulmonary problems and alcohol withdrawal are statistically more important in negatively impacting the outcomes and costs of these microsurgical reconstructions.

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