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Perioperative Risk Prediction in Head and Neck Free Flap Reconstructive Surgery

Persson, Karolina LU orcid ; Torén, Madeleine LU ; Walther Sturesson, Louise LU ; Kander, Thomas LU orcid ; Nilsson, Caroline LU and Sjövall, Johanna LU (2025) In Acta Anaesthesiologica Scandinavica 69(9).
Abstract

BACKGROUND: Extensive head and neck reconstructive surgery is a complex procedure often performed in patients with multiple comorbidities, and the risk of complications is high. Evidence-based preoperative assessment and reliable risk prediction are therefore essential, and the anesthesiologist plays an important role in this process. The aim of this study was to evaluate the predictive properties of readily available clinical parameters for postoperative complications.

METHODS: We performed a retrospective registry study including 388 patients undergoing head and neck free flap surgery between 2009 and 2022. Logistic regression analyses were used to establish associations between perioperative variables and postoperative flap... (More)

BACKGROUND: Extensive head and neck reconstructive surgery is a complex procedure often performed in patients with multiple comorbidities, and the risk of complications is high. Evidence-based preoperative assessment and reliable risk prediction are therefore essential, and the anesthesiologist plays an important role in this process. The aim of this study was to evaluate the predictive properties of readily available clinical parameters for postoperative complications.

METHODS: We performed a retrospective registry study including 388 patients undergoing head and neck free flap surgery between 2009 and 2022. Logistic regression analyses were used to establish associations between perioperative variables and postoperative flap compromise and systemic complications during primary in-hospital stay. Perioperative variables included risk prediction instrument scores, biochemical laboratory values, type of flap, surgery time, and fluids and drugs administered.

RESULTS: Factors associated with flap compromise in multivariable analysis were surgery time (p = 0.005) and perioperative red blood cell transfusion (p = 0.001). American Society of Anesthesiologists Physical Status (ASA-PS) (p = 0.012), Charlson Comorbidity Index (CCI) (p = 0.021) and Head Neck Charlson Comorbidity Index (HN-CCI) (p = 0.024) were factors most significantly associated with systemic complications.

DISCUSSION: Strong association was seen between surgery time and perioperative red blood cell transfusion and flap compromise. ASA-PS, CCI, and its simplified version HN-CCI were shown to be independently associated with systemic complications. To the best of our knowledge, this is the first study demonstrating the value of Head Neck Charlson Comorbidity Index in this setting.

EDITORIAL COMMENT: This single center cohort analysis describes factors associated with head and neck free flap surgery postoperative flap compromise and other major complications. Established comorbidity indices were included in the analysis.

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Please use this url to cite or link to this publication:
author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Free Tissue Flaps, Male, Female, Plastic Surgery Procedures/methods, Middle Aged, Retrospective Studies, Postoperative Complications/epidemiology, Aged, Head and Neck Neoplasms/surgery, Adult, Risk Assessment, Risk Factors
in
Acta Anaesthesiologica Scandinavica
volume
69
issue
9
article number
e70115
publisher
Blackwell Munksgaard
external identifiers
  • pmid:40887752
ISSN
0001-5172
DOI
10.1111/aas.70115
language
English
LU publication?
yes
additional info
© 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.
id
e7f42cdb-2df3-4583-92a0-455745fc42e4
date added to LUP
2025-09-02 14:28:19
date last changed
2025-09-02 14:28:19
@article{e7f42cdb-2df3-4583-92a0-455745fc42e4,
  abstract     = {{<p>BACKGROUND: Extensive head and neck reconstructive surgery is a complex procedure often performed in patients with multiple comorbidities, and the risk of complications is high. Evidence-based preoperative assessment and reliable risk prediction are therefore essential, and the anesthesiologist plays an important role in this process. The aim of this study was to evaluate the predictive properties of readily available clinical parameters for postoperative complications.</p><p>METHODS: We performed a retrospective registry study including 388 patients undergoing head and neck free flap surgery between 2009 and 2022. Logistic regression analyses were used to establish associations between perioperative variables and postoperative flap compromise and systemic complications during primary in-hospital stay. Perioperative variables included risk prediction instrument scores, biochemical laboratory values, type of flap, surgery time, and fluids and drugs administered.</p><p>RESULTS: Factors associated with flap compromise in multivariable analysis were surgery time (p = 0.005) and perioperative red blood cell transfusion (p = 0.001). American Society of Anesthesiologists Physical Status (ASA-PS) (p = 0.012), Charlson Comorbidity Index (CCI) (p = 0.021) and Head Neck Charlson Comorbidity Index (HN-CCI) (p = 0.024) were factors most significantly associated with systemic complications.</p><p>DISCUSSION: Strong association was seen between surgery time and perioperative red blood cell transfusion and flap compromise. ASA-PS, CCI, and its simplified version HN-CCI were shown to be independently associated with systemic complications. To the best of our knowledge, this is the first study demonstrating the value of Head Neck Charlson Comorbidity Index in this setting.</p><p>EDITORIAL COMMENT: This single center cohort analysis describes factors associated with head and neck free flap surgery postoperative flap compromise and other major complications. Established comorbidity indices were included in the analysis.</p>}},
  author       = {{Persson, Karolina and Torén, Madeleine and Walther Sturesson, Louise and Kander, Thomas and Nilsson, Caroline and Sjövall, Johanna}},
  issn         = {{0001-5172}},
  keywords     = {{Humans; Free Tissue Flaps; Male; Female; Plastic Surgery Procedures/methods; Middle Aged; Retrospective Studies; Postoperative Complications/epidemiology; Aged; Head and Neck Neoplasms/surgery; Adult; Risk Assessment; Risk Factors}},
  language     = {{eng}},
  number       = {{9}},
  publisher    = {{Blackwell Munksgaard}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{Perioperative Risk Prediction in Head and Neck Free Flap Reconstructive Surgery}},
  url          = {{http://dx.doi.org/10.1111/aas.70115}},
  doi          = {{10.1111/aas.70115}},
  volume       = {{69}},
  year         = {{2025}},
}