Abstract：
OBJECTIVE: To compare free flap outcomes between those who received and did not receive vasopressors (VPs) at the time of free flap reconstruction.
METHODS: This retrospective cohort study includes patients from January 2013 to January 2023.
METHODS: This multicenter cohort study utilized data from the TriNetX Research Network which includes 80 health care organizations.
METHODS: Head and neck cancer patients older than 18 years who underwent free flap reconstruction were separated into those who received or did not receive VPs on the day of surgery. The primary outcomes were flap failure defined by need for secondary free flap procedures, blood vessel repair, and other flap revision procedures.
RESULTS: After propensity score matching, 7446 patients were analyzed. The VP group included 3723 patients (mean age [SD], 62.9 [11.4] years; 2511 males [67.4%]). The non-VP group included 3723 patients (mean age [SD], 63.0 [11.2] years; 2479 males [66.6%]). Free flap outcomes were not statistically different between groups (secondary free flap: 166 [4.5%] VP vs 155 [4.2%] non-VP, P = .04; vessel repair: 314 [8.4%] vs 319 [8.6%], P = .06; other flap revision procedures: 416 [11.2%] vs 449 [12.1%], P = .02). Bony flaps were found to have decreased rates of vessel repair in the VP group (47 [6.1%] vs 69 [9.0%], P = .003]. For secondary outcomes, pneumonia (173 [4.6%] vs 231 [6.2%], P = .0002), urinary tract infection (34 [1.0%] vs 59 [1.6%], P = .0007), and deep vein thrombosis (93 [2.5%] vs 122 [3.3%], P = .004) were significantly different.
CONCLUSIONS: VP use is not significantly associated with free flap complications. These results imply that VP use on the same day as surgery may be safe if clinically necessary.
METHODS: This retrospective cohort study includes patients from January 2013 to January 2023.
METHODS: This multicenter cohort study utilized data from the TriNetX Research Network which includes 80 health care organizations.
METHODS: Head and neck cancer patients older than 18 years who underwent free flap reconstruction were separated into those who received or did not receive VPs on the day of surgery. The primary outcomes were flap failure defined by need for secondary free flap procedures, blood vessel repair, and other flap revision procedures.
RESULTS: After propensity score matching, 7446 patients were analyzed. The VP group included 3723 patients (mean age [SD], 62.9 [11.4] years; 2511 males [67.4%]). The non-VP group included 3723 patients (mean age [SD], 63.0 [11.2] years; 2479 males [66.6%]). Free flap outcomes were not statistically different between groups (secondary free flap: 166 [4.5%] VP vs 155 [4.2%] non-VP, P = .04; vessel repair: 314 [8.4%] vs 319 [8.6%], P = .06; other flap revision procedures: 416 [11.2%] vs 449 [12.1%], P = .02). Bony flaps were found to have decreased rates of vessel repair in the VP group (47 [6.1%] vs 69 [9.0%], P = .003]. For secondary outcomes, pneumonia (173 [4.6%] vs 231 [6.2%], P = .0002), urinary tract infection (34 [1.0%] vs 59 [1.6%], P = .0007), and deep vein thrombosis (93 [2.5%] vs 122 [3.3%], P = .004) were significantly different.
CONCLUSIONS: VP use is not significantly associated with free flap complications. These results imply that VP use on the same day as surgery may be safe if clinically necessary.
摘要：
目的：比较游离皮瓣重建时接受和未接受血管加压药（VP）的患者的游离皮瓣结局。
方法：这项回顾性队列研究包括2013年1月至2023年1月的患者。
方法：这项多中心队列研究利用了TriNetX研究网络的数据，该网络包括80个医疗机构。
方法：将18岁以上接受游离皮瓣重建的头颈部癌患者分为在手术当天接受或未接受VPs的患者。主要结果是皮瓣失败，定义为需要二次游离皮瓣手术，血管修复,和其他襟翼修正程序。
结果：在倾向得分匹配后，对7446例患者进行分析。VP组包括3723例患者(平均年龄[SD]，62.9[11.4]岁；2511名男性[67.4%]）。非VP组包括3723例患者(平均年龄[SD]，63.0[11.2]岁；2479名男性[66.6%]）。游离皮瓣结果组间无统计学差异(次级游离皮瓣:166[4.5%]VPvs155[4.2%]非VP,P=.04；血管修复：314[8.4%]对319[8.6%]，P=.06；其他皮瓣翻修程序：416[11.2%]vs449[12.1%]，P=.02）。发现VP组的骨皮瓣的血管修复率降低（47[6.1％]vs69[9.0％]，P=0.003]。对于次要结果，肺炎（173[4.6%]vs231[6.2%]，P=.0002),尿路感染（34[1.0%]vs59[1.6%]，P=.0007)，深静脉血栓形成（93[2.5%]vs122[3.3%]，P=.004）有显著差异。
结论：VP使用与游离皮瓣并发症无显著相关性。这些结果表明，如果临床需要，在手术当天使用VP可能是安全的。
方法：这项回顾性队列研究包括2013年1月至2023年1月的患者。
方法：这项多中心队列研究利用了TriNetX研究网络的数据，该网络包括80个医疗机构。
方法：将18岁以上接受游离皮瓣重建的头颈部癌患者分为在手术当天接受或未接受VPs的患者。主要结果是皮瓣失败，定义为需要二次游离皮瓣手术，血管修复,和其他襟翼修正程序。
结果：在倾向得分匹配后，对7446例患者进行分析。VP组包括3723例患者(平均年龄[SD]，62.9[11.4]岁；2511名男性[67.4%]）。非VP组包括3723例患者(平均年龄[SD]，63.0[11.2]岁；2479名男性[66.6%]）。游离皮瓣结果组间无统计学差异(次级游离皮瓣:166[4.5%]VPvs155[4.2%]非VP,P=.04；血管修复：314[8.4%]对319[8.6%]，P=.06；其他皮瓣翻修程序：416[11.2%]vs449[12.1%]，P=.02）。发现VP组的骨皮瓣的血管修复率降低（47[6.1％]vs69[9.0％]，P=0.003]。对于次要结果，肺炎（173[4.6%]vs231[6.2%]，P=.0002),尿路感染（34[1.0%]vs59[1.6%]，P=.0007)，深静脉血栓形成（93[2.5%]vs122[3.3%]，P=.004）有显著差异。
结论：VP使用与游离皮瓣并发症无显著相关性。这些结果表明，如果临床需要，在手术当天使用VP可能是安全的。
