An improved predictive model for postoperative pulmonary complications after free flap reconstructions in the head and neck

The impact of postoperative glucocorticoids on complications after head and neck cancer surgery with free flap reconstruction: A retrospective study

BACKGROUND

After head and neck cancer surgery with free flap reconstruction, the use of glucocorticoids is often required to alleviate inflammation and edema. However, the impact of glucocorticoid on postoperative complications and cancer progression remains unclear.

METHODS

This retrospective cohort study included 711 elderly patients who underwent head and neck cancer surgery with free flap reconstruction at Shanghai Ninth People's Hospital from January 1, 2014, to December 31, 2022. Patients were categorized based on postoperative glucocorticoid usage into a high-dose steroid group (n = 307) and a control group (n = 404). The study focused on the impact of postoperative GC use on postoperative complications and long-term oncological outcomes.

RESULTS

Multivariate analysis indicated that compared to the control group, the high-dose steroid group had a significant increase in postoperative complications, including atelectasis (OR: 3.83, 95% CI: 1.27-14.11, P = 0.025), postoperative hyperglycemia (OR: 1.54, 95% CI: 1.14-2.08, P = 0.006), and flap complications (OR: 4.61, 95% CI: 3.31-6.47, P < 0.001). These complications often required extended hospital stays (β: 1.656, 95% CI: 1.075-2.236, P <  0.001). Additionally, the high-dose steroid group had a higher rate of unplanned readmissions within one year (OR: 5.61, 95% CI: 3.87-8.25, P < 0.001). The increased readmission rates were notably due to difficulties swallowing requiring percutaneous gastrostomy (OR: 3.62, 95% CI: 1.97-6.98, P < 0.001), recurrence (OR: 9.34, 95% CI: 5.02-19.05, P < 0.001), and metastasis (OR: 4.78, 95% CI: 2.58-9.44, P < 0.001).

CONCLUSION

The use of high-dose postoperative glucocorticoids is associated with increased postoperative complications, higher readmission rates, and poorer oncological outcomes in patients. The results advocate for cautious use and dosage management of perioperative glucocorticoids in head and neck surgeries to optimize patient outcomes.

Bidirectional cohort study protocol to construct and validate a prediction model for perioperative pulmonary complications in elderly hip fracture patients

Elderly adults with hip fractures are particularly vulnerable to perioperative pulmonary complications (POPCs) throughout the surgical process. While most studies have focused on predicting postoperative pulmonary complications (PPCs), there has been a lack of focus on preoperative and intraoperative phases. To address this gap, this bidirectional cohort study aims to develop and validate a predictive model for POPCs across all surgical stages in elderly patients with hip fracture. This study will involve 3481 patients, with 1914 in the retrospective dataset and 1567 in the prospective dataset, and will analyse 44 perioperative risk factors. LASSO and multiple logistic regression will be used to identify key predictors, and nomogram prediction models will be constructed via the RMS packages. The accuracy and variability of the model will be assessed using receiver operating characteristic (ROC) curve analysis and calibration plots. The primary outcome measure is the incidence of pulmonary complications from hospital admission to 30 days post-surgery, and the secondary outcomes include complications such as heart failure, myocardial infarction, renal failure, deep venous thrombosis, stroke, and death within 30 days post-surgery. This study aims to construct a comprehensive model for predicting POPCs in this patient population and verify its accuracy and ability to differentiate POPCs using both internal and external data.

Risk Factors for Pulmonary Complications After Major Oral and Maxillofacial Surgery With Free Flap Reconstruction

Background Postoperative pulmonary complications (PPCs) are common and result in increased morbidity and mortality. A variable incidence of PPCs has been reported in patients who have undergone major oral and maxillofacial surgery with free flap reconstruction, which is one of the most extensive forms of head and neck cancer surgery, and perioperative risk factors for PPCs in these patients have not been fully elucidated. Furthermore, the ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) score and Gupta risk index have not been investigated in patients undergoing head and neck cancer surgery. This study aimed to identify perioperative risk factors for PPCs after major oral and maxillofacial surgery with free flap reconstruction. Methodology This was a single-center, retrospective cohort study of 118 patients who had undergone major oral and maxillofacial surgery with free flap reconstruction between 2009 and 2020. PPCs were defined as pneumonia, hypoxemia caused by atelectasis, pleural effusion, pulmonary embolism, pulmonary edema, bronchospasm, pneumothorax, and acute respiratory failure. Predictors of PPCs were identified in univariate and multiple Poisson regression analyses. Results The incidence of PPCs was 18.6% (22/118 patients). The most frequent PPC was pneumonia. No preoperative patient-related parameter was identified to predict PPCs. In univariate analysis, the only predictor was anesthesia time ≥1,140 minutes (odds ratio = 3.0, p = 0.036). Multivariable Poisson regression identified two independent predictors of PPCs, namely, anesthesia time ≥1,140 minutes (incidence rate ratio (IRR) = 2.18, 95% confidence interval (CI) = 1.1-4.3, p = 0.024) and a large amount of intraoperative fluid (IRR = 1.00018, 95% CI = 1.000018-1.000587, p = 0.037). Conclusions Patients undergoing major oral and maxillofacial surgery with free flap reconstruction are at high risk of PPCs. Longer anesthesia time and administering a large amount of fluid during surgery were significantly correlated with the risk of PPCs.