Brady JS, et al. - This study was designed to assess the association of anesthesia duration with complications after microvascular reconstruction of the head and neck. Researchers observed significantly increased rates of surgical complications, especially the requirement for postoperative transfusion with increasing anesthesia duration. They identified no significant change in rates of medical complications, and overall mortality remained unaffected. When performing head and neck free flap surgery, they recommended focusing on avoidance of excessive blood loss and prolonged anesthesia time.

Methods

• Researchers used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
• They recorded, in total, 630 patients who underwent head and neck microvascular reconstruction in the NSQIP registry from January 1, 2005, through December 31, 2013.
• They included patients who underwent microvascular reconstructive surgery performed by otolaryngologists or plastic surgeons.
• They performed data analysis from October 15, 2015, to January 15, 2016.
• Patients underwent microvascular reconstructive surgery of the head and neck.

Results

• Data on anesthesia duration was available of 630 patients undergoing head and neck free flap surgery; inclusion was performed of these patients (mean [SD] age, 61.6 [13.8] years; 436 [69.3%] male).
• As per bivariate analysis, 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).
• Findings revealed no association of increased anesthesia duration with specific medical complications and 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).
• 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) continued to have significant association with increased anesthesia duration; nonsignificant association of wound disruption and increased anasthesia duration was evident (group 5: OR, 2.0; 95% CI, 0.75-5.31; P=.16).