University of Oulu

Lahtinen, S., Nurkkala, J., Hannula, S., Ohtonen, P., Koivunen, P., & Liisanantti, J. H. (2021). Perioperative Risk Factors for One-Year Mortality in Patients With Free-Flap Reconstruction Due to Cancer of the Head and Neck. Journal of Oral and Maxillofacial Surgery, 79(6), 1384.e1-1384.e5.

Perioperative risk factors for one-year mortality in patients with free-flap reconstruction due to cancer of the head and neck

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Author: Lahtinen, Sanna1; Nurkkala, Juho1; Hannula, Samuli2;
Organizations: 1University of Oulu, Medical Research Center, Research Group of Surgery, Anaesthesia and Intensive Care and Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland
2University of Oulu, Medical Research Center, PEDEGO Research Unit, Department of Otorhinolaryngology and Head and Neck, Oulu University Hospital, Oulu, Finland
3University of Oulu, Division of Operative care and Medical Research Center, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
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Language: English
Published: Elsevier, 2021
Publish Date: 2021-09-16


Purpose: Head and neck cancer requiring free-flap reconstruction is associated with relatively high mortality. We aimed to evaluate perioperative risk factors for 1-year mortality in this patient group.

Methods: This is a single-center retrospective analysis of 204 patients operated during 2008 to 2018.

Results: A total of 47 (23.0%) patients died within 1 year. In univariate analysis, there were no differences in the intraoperative course between 1-year survivors and nonsurvivors. Among the 1-year nonsurvivors, preoperative albumin level was lower (39 [36 to 43] vs 42 [39 to 44], P = 0.032) and the Sequential Organ Failure Assessment admission score was higher (4 [3 to 5] vs 3 [2 to 4], P = 0.003) than those of the 1-year survivors. Among the nonsurvivors, the preoperative and postoperative levels of leukocytes were higher (7.6 [6.7 to 9.5] vs 6.9 [5.5 to 8.4], P = 0.002; 11.4 [9.0 to 14.2] vs 8.7 [7.2 to 11.3], P < 0.001). The highest odds ratios for 1-year mortality in multivariate analysis were American Society of Anesthesiologists A classification greater than 2 (3.9 CI 1.4 to 10.5), male gender (4.0 CI 1.5 to 11), and increase in leukocyte count (1.3 CI 1.1 to 1.5).

Conclusions: One-year nonsurvivors had higher American Society of Anesthesiologists classification and were more often men. The postoperative inflammatory markers were higher in nonsurvivors, while the intraoperative course did not have a significant impact on the 1-year mortality.

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Series: Journal of oral and maxillofacial surgery
ISSN: 1531-5053
ISSN-E: 0278-2391
ISSN-L: 1531-5053
Volume: 79
Issue: 6
Pages: 1384.e1 - 1384.e5
DOI: 10.1016/j.joms.2021.02.042
Type of Publication: A1 Journal article – refereed
Field of Science: 3125 Otorhinolaryngology, ophthalmology
3126 Surgery, anesthesiology, intensive care, radiology
Funding: This study was supported by Telma Mäkikyrö Fund.
Copyright information: © 2021 The Authors. Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons. This is an open access article under the CC BY license ( by/4.0/).