Cardiovascular complications in head & neck microvascular flap reconstruction: A retrospective risk stratification and outcomes assessment

Abstract

Background: To determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction.

Methods: A series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson Comorbidity Index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes.

Results: Twenty patients developed CC (9.7%) with transient cardiac arrhythmia (6.5%) and myocardial infarction (2.8%) occurring most frequently. Univariate analyses demonstrated significant differences between the two groups in terms of their age, smoking status, occurrence of peripheral vascular disease, CCI, RCRI, length of hospitalization and duration of anesthesia. Multivariate analyses showed that RCRI (p < 0.001) and amount of blood transfused (p = 0.02) were independent predictors of CC.

Conclusions: Cardiac complications are uncommon in head and neck microvascular flap surgery. The RCRI is a useful screening tool for estimating cardiac complication risk and improving patient and flap outcomes.

Keywords: Cardiac; Complications; Head and neck reconstruction; Revised cardiac risk index.