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Predictive factors for prolonged operative time in head and neck patients undergoing free flap reconstruction.
Lindeborg, Michael M; Puram, Sidharth V; Sethi, Rosh K V; Abt, Nicholas; Emerick, Kevin S; Lin, Derrick; Deschler, Daniel G.
Afiliação
  • Lindeborg MM; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
  • Puram SV; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
  • Sethi RKV; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
  • Abt N; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
  • Emerick KS; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
  • Lin D; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
  • Deschler DG; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. Electronic address: daniel_deschler@meei.harvard.edu.
Am J Otolaryngol ; 41(2): 102392, 2020.
Article em En | MEDLINE | ID: mdl-31918856
PURPOSE: Defining the predictive factors associated with prolonged operative time may reduce post-operative complications, improve patient outcomes, and decrease cost of care. The aims of this study are to 1) analyze risk factors associated with prolonged operative time in head and neck free flap patients and 2) determine the impact of lengthier operative time on surgical outcomes. METHODS: This retrospective cohort study evaluated 282 head and neck free flap reconstruction patients between 2011 and 2013 at a tertiary care center. Perioperative factors investigated by multivariate analyses included gender, age, American Society of Anesthesiologists class, tumor subsite, stage, flap type, preoperative comorbidities, and perioperative hematocrit nadir. Association was explored between operative times and complications including flap take back, flap survival, transfusion requirement, flap site hematoma, and surgical site infection. RESULTS: Mean operative time was 418.2 ± 88.4 (185-670) minutes. Multivariate analyses identified that ASA class III (beta coefficient + 24.5, p = .043), stage IV tumors (+34.8, p = .013), fibular free flaps (-44.8, p = .033 for RFFF vs. FFF and - 67.7, p = .023 for ALT vs FFF) and COPD (+36.0, p = .041) were associated with prolonged operative time. History of CAD (-43.5, p = .010) was associated with shorter operative time. There was no statistically significant association between longer operative time and adverse flap outcomes or complications. CONCLUSION: As expected, patients who were medically complex, had advanced cancer, or underwent complex flap reconstruction had longer operative times. Surgical planning should pay special attention to certain co-morbidities such as COPD, and explore innovative ways to minimize operative time. Future research is needed to evaluate how these factors can help guide planning algorithms for head and neck patients.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Retalhos Cirúrgicos / Procedimentos de Cirurgia Plástica / Duração da Cirurgia / Neoplasias de Cabeça e Pescoço Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Retalhos Cirúrgicos / Procedimentos de Cirurgia Plástica / Duração da Cirurgia / Neoplasias de Cabeça e Pescoço Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article