Higher perioperative fluid administration is associated with increased rates of complications following head and neck microvascular reconstruction with fibular free flaps

• Published in: Microsurgery 2017-02, Vol.37 (2), p.128-136
• Main Authors: Ettinger, Kyle S., Arce, Kevin, Lohse, Christine M., Peck, Brandon W., Reiland, Matthew D., Bezak, Brett J., Moore, Eric J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Female; Fibula - blood supply; Fibula - transplantation; Fluid Therapy - adverse effects; Fluid Therapy - methods; Free Tissue Flaps; Head and Neck Neoplasms - surgery; Humans; Male; Middle Aged; Perioperative Care; Postoperative Complications - etiology; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Retrospective Studies; Risk Factors; Young Adult
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.30061

Purpose The purpose of this study is to evaluate the impact of perioperative fluid administration on the rates of postoperative complications following head and neck reconstruction with fibular free flaps (FFF). Methods A retrospective cohort study of subjects undergoing head and neck reconstruction with FFF was completed. The primary predictor variable was the total volume of perioperative fluids administered on the day of surgery. The primary outcome variable was the presence of medical and surgical complications occurring within 30 days of surgery. Medical and surgical complications were stratified as major or minor based on severity level. Basic demographic information, comorbidity indices, and intraoperative parameters were ed as covariates. Univariable and multivariable models were developed to assess for associations between total fluid volume administered on the day of surgery and postoperative medical/surgical complications occurring within 30 days of surgery. Results In 154 subjects, the partial flap failure rate was 3% and there were no complete flap failures. Total fluid volume was significantly associated with the presence of postoperative medical/surgical complications (OR = 1.21; 95% CI: 1.02–1.44; p = 0.032). A cutpoint for total fluid volume predicting any severity level of postoperative complication was identified at 5,500 mL. A cutpoint for total fluid volume predicting major postoperative complications was identified at 7,000 mL. Conclusions The results of this study suggest that liberal fluid administration is associated with increased rates of medical/surgical complications following head and neck reconstruction with FFF. © 2016 Wiley Periodicals, Inc. Microsurgery 37:128–136, 2017.