Analysis of 30 Day Mortality after Free Flap Reconstructions for Head and Neck Cancer Patients: A Propensity-Score Matched Analysis of a Nationwide, Population-Based Cohort Study

INTRODUCTION 

Thirty-day postoperative mortality is the principal index for assessing operative outcomes,1,2 and has been infrequently examined in reconstructive microsurgery for head and neck cancer (HNC) patients. The aims of this study were to determine the incidence, associated pre-operative comorbidities, and postoperative complications in this group of patients. 

METHOD 

A nationwide cohort study using Taiwan's National Health Insurance (NHI) Research Database was conducted for HNC patients who underwent free flap reconstructions between January 1998 and December 2010. A retrospective analysis of 16325 free flap procedures was performed and 30-day postoperative fatal cases were identified. Each case of patient mortality was randomly matched with 10 patients without 30-day mortality, allowing logistic regression to be calculated by propensity-score matching. 

RESULTS 

The 30-day postoperative mortality rate was 0.48 % (79 out of 16325 patients). It was significantly correlated with increased age per one year [adjusted odds ratio (aOR): 1.06; 95% Confidence Interval (CI): 1.04 to 1.09], chronic renal failure (aOR: 5.23; 95% CI: 2.22 to 12.3) and ischemic heart disease (aOR: 1.82; 95% CI: 1.03 to 3.22). Associated postoperative complications were acute renal failure (aOR: 35.9; 95% CI: 11.7 to 110.4), acute myocardial infarction (aOR: 18.6; 95% CI: 4.91 to 70.4), stroke (aOR: 5.41; 95% CI: 3.32 to 8.81), pneumonia (aOR: 3.86: 95% CI :1.91 to 7.82), and septicemia (aOR: 2.45; 95% CI: 1.40 to 4.27). 

CONCLUSION 

In our population study, HNC free flap reconstruction was associated with a low mortality. Careful pre-operative counselling and patient selection should be undertaken for elderly patients, with chronic kidney and ischemic heart diseases in order to avoid complications. 

REFERENCES 

1. Tanaka K, Sakuraba M, Miyamoto S, et al. Analysis of operative mortality and post-operative lethal complications after head and neck reconstruction with free tissue transfer. Jpn J Clin Oncol. 2011. doi:10.1093/jjco/hyr046
2. Mahmoudi E, Lu Y, Chang SC, et al. The associations of hospital volume, surgeon volume, and surgeon experience with complications and 30-day rehospitalization after free tissue transfer: A national population study. Plast Reconstr Surg. 2017. doi:10.1097/PRS.0000000000003515