Perioperative Outcomes in Patients Who Underwent Fibula, Osteocutaneous Radial Forearm, and Scapula Free Flaps: A Multicenter Study.

Autor:	Bollig CA; Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey., Walia A; Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri., Pipkorn P; Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri., Jackson R; Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri., Puram SV; Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri., Rich JT; Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri., Paniello RC; Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri., Zevallos JP; Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri., Stevens MN; Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Wood CB; Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis., Rohde SL; Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Sykes KJ; Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City., Kakarala K; Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City., Bur A; Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City., Wieser ME; Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia., Galloway TLI; Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia., Tassone P; Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia., Llerena P; Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey., Bollig KJ; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia., Mattingly TR; Department of Otolaryngology Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky., Pluchino T; Department of Otolaryngology Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky., Jorgensen JB; Division of Otolaryngology Head and Neck Surgery, PRISMA Health, Greenville, South Carolina.
Jazyk:	angličtina
Zdroj:	JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2022 Oct 01; Vol. 148 (10), pp. 965-972.
DOI:	10.1001/jamaoto.2022.2440
Abstrakt:	Importance: Studies comparing perioperative outcomes of fibula free flaps (FFFs), osteocutaneous radial forearm free flaps (OCRFFFs), and scapula free flaps (SFFs) have been limited by insufficient sample size. Objective: To compare the perioperative outcomes of patients who underwent FFFs, OCRFFFs, and SFFs. Design, Setting, and Participants: This cohort study assessed the outcomes of 1022 patients who underwent FFFs, OCRFFFs, or SFFs for head and neck reconstruction performed at 1 of 6 academic medical centers between January 2005 and December 2019. Data were analyzed from September 17, 2021, to June 9, 2022. Main Outcomes and Measures: Patients were stratified based on the flap performed. Evaluated perioperative outcomes included complications (overall acute wound complications, acute surgical site infection [SSI], fistula, hematoma, and flap failure), 30-day readmissions, operative time, and prolonged hospital length of stay (75th percentile, >13 days). Patients were excluded if data on flap type or clinical demographic characteristics were missing. Associations between flap type and perioperative outcomes were analyzed using logistic regression, after controlling for other clinically relevant variables. Adjusted odds ratios (aORs) with 95% CIs were generated. Results: Perioperative outcomes of 1022 patients (mean [SD] age, 60.7 [14.5] years; 676 [66.1%] men) who underwent major osseous head and neck reconstruction were analyzed; 510 FFFs (49.9%), 376 OCRFFFs (36.8%), and 136 SFFs (13.3%) were performed. Median (IQR) operative time differed among flap types (OCRFFF, 527 [467-591] minutes; FFF, 592 [507-714] minutes; SFF, 691 [610-816] minutes). When controlling for SSI, FFFs (aOR, 2.47; 95% CI, 1.36-4.51) and SFFs (aOR, 2.95; 95% CI, 1.37-6.34) were associated with a higher risk of flap loss than OCRFFFs. Compared with OCRFFFs, FFFs (aOR, 1.77; 95% CI, 1.07-2.91) were associated with a greater risk of fistula after controlling for the number of bone segments and SSI. Both FFFs (aOR, 1.77; 95% CI, 1.27-2.46) and SFFs (aOR, 1.68; 95% CI, 1.05-2.69) were associated with an increased risk of 30-day readmission compared with OCRFFFs after controlling for Charlson-Deyo comorbidity score and acute wound complications. Compared with OCRFFFs, FFFs (aOR, 1.78; 95% CI, 1.25-2.54) and SFFs (aOR, 1.96; 95% CI, 1.22-3.13) were associated with a higher risk of prolonged hospital length of stay after controlling for age and flap loss. Conclusions and Relevance: Findings of this cohort study suggest that perioperative outcomes associated with OCRFFFs compare favorably with those of FFFs and SFFs, with shorter operative times and lower rates of flap loss, 30-day readmissions, and prolonged hospital length of stay. However, patients undergoing SFFs represented a more medically and surgically complex population than those undergoing OCRFFFs or FFFs.
Databáze:	MEDLINE
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