Perioperative risk factors for one-year mortality in patients with free-flap reconstruction due to cancer of the head and neck
Lahtinen, Sanna; Nurkkala, Juho; Hannula, Samuli; Ohtonen, Pasi; Koivunen, Petri; Liisanantti, Janne H. (2021-03-06)
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. https://doi.org/10.1016/j.joms.2021.02.042
© 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 (http://creativecommons.org/licenses/ by/4.0/).
https://creativecommons.org/licenses/by/4.0/
https://urn.fi/URN:NBN:fi-fe2021091646382
Tiivistelmä
Abstract
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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