(153) Effect of Comorbidity on Postoperative Outcomes in Free Tissue Transfer

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

Presenting Author(s)

Andrew R. Mangan, B.S.

Medical Student
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States
Kenzo Cotton

Student
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States

Co-Author(s)

Kenzo Cotton

Student
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States
James R. Gardner, MD

Resident Physician
University of Arkansas for Medical Sciences
Little Rock, AR, USA
AS

Aryan D. Shay, MD

Resident
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States
EV

Emre A. Vural, MD

Professor
University of Arkansas for Medical Sciences
Little Rock, AR, United States
Mauricio A. Moreno-Vera, MD

Professor
University of Arkansas for Medical Sciences
Little Rock, AR, United States

Senior Author(s)

JS

Jumin Sunde, MD

University of Arkansas for Medical Sciences, USA

Disclosure(s):

Andrew R. Mangan, B.S.: No relevant relationships to disclose.

Kenzo Cotton: No relevant relationships to disclose.

Aryan D. Shay, MD: No relevant relationships to disclose.

Introduction: Free flap reconstruction is commonly necessary in the surgical management of patients with advanced head and neck cancer. In this series we seek to better predict postoperative outcomes based on preoperative demographics and comorbidities using two validated risk stratification tools.

Methods: Retrospective chart review was performed on 113 patients who underwent free flap reconstruction of the head and neck from 2020-2022. Charleston comorbidity index (CCI) and 5-Factor Modified Frailty Index (5-fMI) were calculated for all patients. CCI scored patients on a scale from 0-37, with 0 having the fewest comorbidities, and 5-mFI scored patients from 0-5, with 0 being the lowest score of frailty. This data was analyzed to determine whether a significant relationship existed between preoperative comorbidities and postoperative complications. Statistical alpha was set at 0.05.

Results: The mean age was 62.2 years old and 64.6% were male. 78.5% of the reconstructions were performed for the treatment of cancer. The most common site of reconstruction was the oral cavity. The most common free flap utilized was the anterolateral thigh (39.5%), followed by the fibular free flap (31.0%). The average length of stay was 7.36 days, and the median length of stay was 5 days. On the 5-fMI, patients scored 0 (25.8%), 1 (36.7%), 2 (23.45%), 3 (11.7%), 4 (0.8%), and 5 (1.6%). The mean CCI score was 4.6. The 5-mFI was significantly correlated with surgical hematomas (p=0.008), the need to reoperate (p=0.020), ARDS (p=0.011), and Sepsis (p=0.001). The CCI was significant for readmission (p=0.017), death (p=0.042), multiple medical complication (p=0.040). Cerebrovascular disease (p=0.001) and congestive heart failure (p=0.001) were significant predictors for length of stay.

Conclusions: The CCI and 5-fMI are validated tools used to assess comorbidities in the hospital setting. Patients who had higher scores in either of these indexes were at a significantly higher risk of post operative medical and surgical complications. The greatest of these risk factors include cerebrovascular disease, congestive heart failure, and diabetes.