Among patients undergoing microvascular reconstruction of the head and neck, longer anesthesia exposure was associated with increased surgical complication rates.
The study included 630 patients from the American College of Surgeons National Surgical Quality Improvement Program database who underwent head and neck microvascular reconstruction between Jan. 1, 2005, and Dec. 31, 2013. Otolaryngologists or plastic surgeons operated on eligible participants who were assessed for medical and surgical complications, and mortality.
The researchers stratified patients into five groups based on mean anesthesia duration: group 1, 358.1 (standard deviation [SD], 175.6) minutes; group 2, 563.2 (SD, 27.3) minutes; group 3, 648.9 (SD, 24) minutes; group 4, 736.5 (SD, 26.3) minutes; and group 5, 922.1 (SD, 128.1) minutes.
Bivariate analysis results indicated that overall 30-day complications occurred in 43.7% of patients in group 1 and 63.5% of those in group 5 (P = .006).
Similarly, 30-day postoperative surgical complications occurred in 35.7% of patients in group 1 compared with 61.9% of those in group 5 (P < .001) on bivariate analysis. Also in this analysis, postoperative transfusion rates were increased with longer anesthesia exposure (group 1, 25.4% vs. group 5, 55.6%; P < .001), as were rates of wound disruption (group 1, 0 vs. group 5, 7.9%; P = .02).
Other findings from the bivariate analysis showed that no specific medical complications and no overall medical complication rate were not associated with a longer duration of anesthesia (group 1, 19% vs. group 2, 17.5%; P = .80). In addition, the mortality rate was 0.8% in groups 1 and 5 (P = .75).
Multivariable analysis results showed a significant association between increased anesthesia duration and overall complications (group 5, OR = 1.98; P = .02), surgical complications (group 5, OR = 2.46; P = .003) and postoperative transfusion (group 5, OR = 2.31; P = .006). Additional multivariate results demonstrated a nonsignificant association between wound disruption and increased anesthesia duration (group 5, OR = 2; P = .16).
“Avoidance of excessive blood loss and prolonged anesthesia time should be the goal when performing head and neck free flap surgery,” the researchers concluded. – by Rob Volansky
Disclosures: The authors report no relevant financial disclosures.