The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology
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The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology. / Pohlenz, P; Klatt, J; Schmelzle, R; Li, L.
in: BRIT J ORAL MAX SURG, Jahrgang 51, Nr. 6, 01.09.2013, S. 508-13.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology
AU - Pohlenz, P
AU - Klatt, J
AU - Schmelzle, R
AU - Li, L
N1 - Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
PY - 2013/9/1
Y1 - 2013/9/1
N2 - Mortality is a rare but disastrous complication of microvascular head and neck reconstruction. The investigators attempt to identify the procedure-related mortality cases and analyse the causes of death. A retrospective analysis of 804 consecutive free flap procedures during a 19-year period was performed and fatal cases were identified (n=42 deaths). Multivariate logistic regression was employed to determine the association of in-hospital mortality with patient-related characteristics. The 30-day post-operative mortality rate was 1% (8 out of 804 patients), and the in-hospital mortality rate (post-operative deaths in-hospital before or after the 30th post-operative day without discharge) was 5.2% (42 out of 804 patients). Cancer recurrence and metastases related pneumonia were the most common causes of death (n=26, 62%), followed by cardiac, pulmonary, infectious and hepatic/renal aetiologies. Logistic regression analysis revealed that patients with stage IV disease and an operation time of >9h were significantly associated with post-operative mortality. Malignancy-related conditions were the most common causes of death following free flap transfer for head and neck reconstruction. For patients with stage IV head and neck cancer, this aggressive surgical approach should be cautiously justified due to its association with post-operative mortality. To shorten the operation time, experienced microsurgical operation teams are necessary.
AB - Mortality is a rare but disastrous complication of microvascular head and neck reconstruction. The investigators attempt to identify the procedure-related mortality cases and analyse the causes of death. A retrospective analysis of 804 consecutive free flap procedures during a 19-year period was performed and fatal cases were identified (n=42 deaths). Multivariate logistic regression was employed to determine the association of in-hospital mortality with patient-related characteristics. The 30-day post-operative mortality rate was 1% (8 out of 804 patients), and the in-hospital mortality rate (post-operative deaths in-hospital before or after the 30th post-operative day without discharge) was 5.2% (42 out of 804 patients). Cancer recurrence and metastases related pneumonia were the most common causes of death (n=26, 62%), followed by cardiac, pulmonary, infectious and hepatic/renal aetiologies. Logistic regression analysis revealed that patients with stage IV disease and an operation time of >9h were significantly associated with post-operative mortality. Malignancy-related conditions were the most common causes of death following free flap transfer for head and neck reconstruction. For patients with stage IV head and neck cancer, this aggressive surgical approach should be cautiously justified due to its association with post-operative mortality. To shorten the operation time, experienced microsurgical operation teams are necessary.
KW - Adult
KW - Aged
KW - Carcinoma, Squamous Cell
KW - Free Tissue Flaps
KW - Germany
KW - Head and Neck Neoplasms
KW - Heart Arrest
KW - Hospital Mortality
KW - Humans
KW - Liver Failure
KW - Microsurgery
KW - Middle Aged
KW - Myocardial Infarction
KW - Neoplasm Metastasis
KW - Neoplasm Recurrence, Local
KW - Neoplasm Staging
KW - Operative Time
KW - Pneumonia
KW - Postoperative Complications
KW - Pulmonary Embolism
KW - Reconstructive Surgical Procedures
KW - Renal Insufficiency
KW - Retrospective Studies
KW - Surgical Wound Infection
U2 - 10.1016/j.bjoms.2012.10.020
DO - 10.1016/j.bjoms.2012.10.020
M3 - SCORING: Journal article
C2 - 23369783
VL - 51
SP - 508
EP - 513
JO - BRIT J ORAL MAX SURG
JF - BRIT J ORAL MAX SURG
SN - 0266-4356
IS - 6
ER -