Analysis of Risk Factors for Unplanned Reoperation Following Free Flap Surgery of the Head and Neck

Abstract

Objectives/hypothesis: Evaluate risk factors for unplanned reoperation following free flap surgery of the head and neck.

Study design: Retrospective database review.

Methods: The National Surgical Quality Improvement Program database was queried for free flap surgeries of the head and neck between 2010 and 2014. Bivariate and multivariate analyses were performed to compare perioperative variables and postoperative complications in patients with and without unplanned reoperation.

Results: A total of 1,796 patients were identified, with an overall unplanned reoperation rate of 20.0% (n = 359) within 30 days after surgery. Upon multivariate analysis, independent preoperative risk factors for unplanned reoperation include smoking (odds ratio [OR]: 1.389, 95% confidence interval [CI]: 1.042-1.850), hypertension (OR: 1.443, 95% CI: 1.096-1.901), and prior open wound/wound infection (OR: 1.675, 95% CI: 1.123-2.499). Intraoperative risk factors include prolonged operative time (OR: 1.045, 95% CI: 1.021-1.070). Surgical site infection (OR: 6.518, 95% CI: 2.728-15.574), wound disruption (OR: 17.034, 95% CI: 8.373-34.654), blood transfusion (OR: 1.561, 95% CI: 1.062-2.296), and ventilation > 48 hours (OR: 3.626, 95% CI: 1.955-6.723) were significant postoperative predictors of unplanned reoperation.

Conclusions: In patients with free flap surgeries of the head and neck, preoperative smoking, hypertension, and prior open wound/wound infection, along with prolonged operative time, are risk factors for 30-day unplanned reoperation. In addition, postoperative surgical site infection, wound disruption, blood transfusion, and ventilation >48 hours are independently associated with unplanned reoperation.

Level of evidence: 4 Laryngoscope, 128:2790-2795, 2018.

Keywords: Free flap surgery; National Surgical Quality Improvement Program; head and neck; risk factors; unplanned reoperation.