(283) Intraoperative Vasopressor Use Does Not Affect Free Flap Viability

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

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Presenting Author(s)

Zachary M. Huttinger, MD, PhD

Resident Physician
The Ohio State University
Columbus, Ohio, United States

Co-Author(s)

HK

Hannah N. Kuhar, MD

The Ohio State University, USA
Hilary C. McCrary, MD

Assistant Professor of Otolaryngology - Head and Neck Surgery
University of Utah
Columbus, Ohio, United States
Janice L. Farlow, MD PhD

Assistant Professor
Indiana University
Indianapolis, Indiana, United States

Senior Author(s)

Matthew O. Old, MD

Professor and Director, Otolaryngology Head and Neck Surgery
The Ohio State University
Columbus, OH, United States

Disclosure(s):

Zachary M. Huttinger, MD, PhD: No relevant relationships to disclose.

Hilary C. McCrary, MD: No relevant relationships to disclose.

Janice L. Farlow, MD PhD: No relevant relationships to disclose.

Matthew O. Old, MD: No relevant relationships to disclose.

Introduction: Microvascular free tissue transfer is often required for reconstruction after complex head and neck resections. During these operations, vasopressors are occasionally used to maintain mean arterial pressure. Theoretically, these can negatively affect free tissue transfer via vasoconstriction, although the data regarding this are mixed. The aim of this study is to evaluate flap outcomes at a single high-volume institution.

Methods: As part of an IRB-approved prospective study evaluating clinical outcomes of Enhanced Recovery After Surgery protocols, patients undergoing free flap reconstruction at a tertiary academic medical center from January 2020 to December 2022 were reviewed. Patient demographics, operative details, intraoperative vasopressor use, and post operative complications were extracted. Primary outcome was flap failure. Secondary outcomes were reoperation, mortality, or readmission within 30 days, as well as flap revision, hematoma, fistula, infection, and dehiscence. Uni- and multi-variate statistical analysis was performed using SPSS (IBM).

Results: A total of 817 microvascular free flap cases, including 608 soft tissue (74.4%) and 209 osseous flaps (25.6%) were identified. Flap failure occurred in 28 cases (3.4%); 15 (53.6%) of these failures involved intraoperative vasopressor use. Intraoperative vasopressor use was not significantly associated with overall flap failure (p = 0.34), soft tissue flap failure (p = 0.80), nor osseous flap failure (p = 0.06). Intraoperative vasopressor use was not significantly associated (p> 0.05) with need for flap revision, 30-day reoperation, 30-day mortality, 30-day readmission, or other complications (hematoma, fistula, infection, dehiscence).

Conclusions: Here we present the largest single-institution study of patients undergoing head and neck microvascular free flap reconstruction and found no association between flap failure or complications with intraoperative vasopressor use. The association between flap failure and vasopressor use trended towards significance in osseous flaps, suggesting further studies are warranted.