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Original Investigation
October 5, 2017

Association of Anesthesia Duration With Complications After Microvascular Reconstruction of the Head and Neck

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
  • 2Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
  • 3Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
  • 4Department of Ophthalmology, Rutgers New Jersey Medical School, Newark
  • 5Department of Anesthesiology, Rutgers New Jersey Medical School, Newark
JAMA Facial Plast Surg. Published online October 5, 2017. doi:10.1001/jamafacial.2017.1607
Key Points

Questions  Does increased anesthesia duration increase rates of specific postoperative complications in free flap reconstruction of the head and neck?

Findings  In this study of 630 patients who underwent head and neck free flap procedures, those who were obese, had an osseous free flap, or had multiple free flaps were found to have longer anesthesia duration. After confounding factors were accounted for, increased anesthesia duration was associated with increased rates of overall postoperative complications, surgical complications, and transfusions.

Meaning  Increasing anesthesia duration was associated with significantly increased rates of surgical complications, especially the requirement for postoperative transfusion; therefore, avoidance of excessive blood loss and prolonged anesthesia time should be the goal of the reconstructive surgeon when performing head and neck free flap surgery.

Abstract

Importance  Prolonged anesthesia and operative times have deleterious effects on surgical outcomes in a variety of procedures. However, data regarding the influence of anesthesia duration on microvascular reconstruction of the head and neck are lacking.

Objective  To examine the association of anesthesia duration with complications after microvascular reconstruction of the head and neck.

Design, Setting, and Participants  The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to collect data. In total, 630 patients who underwent head and neck microvascular reconstruction were recorded in the NSQIP registry from January 1, 2005, through December 31, 2013. Patients who underwent microvascular reconstructive surgery performed by otolaryngologists or plastic surgeons were included in this study. Data analysis was performed from October 15, 2015, to January 15, 2016.

Exposures  Microvascular reconstructive surgery of the head and neck.

Main Outcomes and Measures  Patients were stratified into 5 quintiles based on mean anesthesia duration and analyzed for patient characteristics and operative variables (mean [SD] anesthesia time: group 1, 358.1 [175.6] minutes; group 2, 563.2 [27.3] minutes; group 3, 648.9 [24.0] minutes; group 4, 736.5 [26.3] minutes; and group 5, 922.1 [128.1] minutes). Main outcomes include rates of postoperative medical and surgical complications and mortality.

Results  A total of 630 patients undergoing head and neck free flap surgery had available data on anesthesia duration and were included (mean [SD] age, 61.6 [13.8] years; 436 [69.3%] male). Bivariate analysis revealed that increasing anesthesia duration was associated with increased 30-day complications overall (55 [43.7%] in group 1 vs 80 [63.5%] in group 5, P = .006), increased 30-day postoperative surgical complications overall (45 [35.7%] in group 1 vs 78 [61.9%] in group 5, P < .001), increased rates of postoperative transfusion (32 [25.4%] in group 1 vs 70 [55.6%] in group 5, P < .001), and increased rates of wound disruption (0 in group 1 vs 10 [7.9%] in group 5, P = .02). No specific medical complications and no overall medical complication rate (24 [19.0%] in group 1 vs 22 [17.5%] in group 5, P = .80) or mortality (1 [0.8%] in group 1 vs 1 [0.8%] in group 5, P = .75) were associated with increased anesthesia duration. On multivariate analysis accounting for demographics and significant preoperative factors including free flap type, overall complications (group 5: odds ratio [OR], 1.98; 95% CI, 1.10-3.58; P = .02), surgical complications (group 5: OR, 2.46; 95% CI, 1.35-4.46; P = .003), and postoperative transfusion (group 5: OR, 2.31; 95% CI, 1.27-4.20; P = .006) remained significantly associated with increased anesthesia duration; the association of wound disruption and increased anasthesia duration was nonsignificant (group 5: OR, 2.0; 95% CI, 0.75-5.31; P = .16).

Conclusions and Relevance  Increasing anesthesia duration was associated with significantly increased rates of surgical complications, especially the requirement for postoperative transfusion. Rates of medical complications were not significantly altered, and overall mortality remained unaffected. Avoidance of excessive blood loss and prolonged anesthesia time should be the goal when performing head and neck free flap surgery.

Level of Evidence  3.

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