Impact of Goal Directed Therapy in Head and Neck Oncological Surgery with Microsurgical Reconstruction: Free Flap Viability and Complications
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Demographic Data
2.2. Surgical Data
2.3. Fluid Management and Vasopressor Data
2.4. Length of Stay
2.5. Postoperative Results
3. Discussion
4. Materials and Methods
4.1. Study Design
4.2. Parameters Collected
- Demographic data
- Age
- Weight
- Sex
- Preoperative factors
- Smoking
- High blood pressure
- Chronic obstructive pulmonary disease
- Alcoholism
- Dyslipidaemia
- Previous chemotherapy
- Previous radiation therapy
- Acute myocardial infarction
- History of arrhythmia
- Presence of hypoalbuminemia
- Diabetes mellitus
- ASA classification
- Haemoglobin level, presence of preoperative anaemia
- Background medication: antidepressants, benzodiazepines, antihypertensives (CC blockers, ACE inhibitors/ARBs, beta blockers)
- Anticoagulants/antiplatelet agents
- Intraoperative factors
- Use or non-use of FloTraq®
- Type of flap
- Bone/non-bone flap
- Surgical time
- Need for transfusion (volume)
- Tracheotomy
- Neck dissection
- Fluid therapy
- Crystalloids
- Colloids
- Vasopressors
- Postoperative factors
- PACU length of stay (hours)
- Hospital length of stay (days)
- Time on ventilator (hours)
- Twenty-four hour fluid therapy
- Crystalloids
- Colloids
- Need for transfusion
- Vasopressors
- Postoperative complications
- Bleeding
- Thrombosis
- Other complications
- Pneumonia
- Arrhythmia
- Ischaemic heart disease
- Pulmonary thromboembolism
- Deep vein thrombosis
- Congestive heart failure
- Confusion
- Cerebral vascular accident (CVA)
- Creatinine above 1.2 mg/mL
- Creatinine greater than 24 h per month
- Diuresis first 24 h
- Antiplatelet/anticoagulant medication at the time of pedicle section
- Heparin
- Lysine acelsalicylate
- Antithrombotic prophylaxis 12 h before the procedure
- 40 IU low molecular weight heparin (LMWH)/no
- Graft outcome
- Necrosis
- Partial (flaps rescued in a subsequent surgical review)
- Total
- Viability
- Survival
- Yes/No
4.3. Sample Size Calculation
4.4. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Conventional Fluid Management (CFM) | Goal Directed Therapy (GDT) | |
---|---|---|
Gender (male) % | 49.1 | 57.9 |
Age, years (median, interquartile range) | 58 (18/87) | 58.50 (18/81) |
Weight, kilograms (median, interquartile range) | 65 (45/95) | 65 (46/127) |
CFM | GDT | |
---|---|---|
Smoker (%) | 51.9 | 48.1 |
Hypertension (%) | 48.9 | 51.1 |
Chronic pulmonary disease (%) | 51.5 | 48.5 |
Alcoholism (%) | 55.3 | 44.7 |
Dyslipidaemia (%) | 52 | 48 |
Ischaemic heart disease (%) | 1.4 | 8.5 |
Arrhythmia (%) | 1.4 | 5.2 |
Hypoalbuminemia (%) | 4.3 | 3.4 |
Diabetes mellitus (%) | 1.4 | 6.8 |
Anaemia (%) | 17.9 | 22.8 |
CFM | GDT | |
---|---|---|
Antidepressants (%) | 11.6 | 8.5 |
Benzodiazepines (%) | 23.2 | 18.6 |
Calcium channels (CC) blockers (%) | 4.3 | 10.2 |
Angiotensin-converting enzyme (ACE) inhibitors)/Angiotensin II receptor blockers (ARBs) (%) | 19.1 | 33.9 |
Beta-blockers (%) | 8.7 | 6.9 |
CFM | GDT | |
---|---|---|
Anterolateral thigh | 25% | 21.7% |
Radial/cubital/forearm | 29.2% | 41.7% |
Fibula | 36.1% | 21.7% |
Iliac crest | 4.2% | 3.3% |
Scapula bone | 1.4% | 0% |
Others | 4.1% | 11.6% |
Yes | No | p Value | |
---|---|---|---|
Free flap bleeding (%) | 12.5 | 52.4 | * |
Free flap thrombosis (%) | 75.8 | 90 | * |
Medical/surgical complications (%) | 25.6 | 20.3 | 0.633 |
Renal failure (first 48h/30 days) | 14.7/13 | 14.1/3.2 | */* |
Yes | No | p Value | |
---|---|---|---|
Free flap bleeding (%) | 42.9 | 46.7 | 1 |
Free flap | 78,6 | 100 | * |
thrombosis (%) | |||
Medical/surgical complications (%) | 25.4 | 20.5 | 0.641 |
Renal failure (%) | 15.9/6.5 | 14/9.8 | 1/* |
(24 h/30 days) |
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Tapia, B.; Garrido, E.; Cebrian, J.L.; Del Castillo, J.L.; Gonzalez, J.; Losantos, I.; Gilsanz, F. Impact of Goal Directed Therapy in Head and Neck Oncological Surgery with Microsurgical Reconstruction: Free Flap Viability and Complications. Cancers 2021, 13, 1545. https://doi.org/10.3390/cancers13071545
Tapia B, Garrido E, Cebrian JL, Del Castillo JL, Gonzalez J, Losantos I, Gilsanz F. Impact of Goal Directed Therapy in Head and Neck Oncological Surgery with Microsurgical Reconstruction: Free Flap Viability and Complications. Cancers. 2021; 13(7):1545. https://doi.org/10.3390/cancers13071545
Chicago/Turabian StyleTapia, Blanca, Elena Garrido, Jose Luis Cebrian, Jose Luis Del Castillo, Javier Gonzalez, Itsaso Losantos, and Fernando Gilsanz. 2021. "Impact of Goal Directed Therapy in Head and Neck Oncological Surgery with Microsurgical Reconstruction: Free Flap Viability and Complications" Cancers 13, no. 7: 1545. https://doi.org/10.3390/cancers13071545