■确定肿瘤切除后显微外科头颈部重建术后30天死亡率的发生率和危险因素。
■回顾性病例对照研究。
■美国外科医生学会国家外科质量改进计划(NSQIP)数据库。
■2005年至2018年,使用当前程序术语代码和使用国际疾病分类9和10代码的肿瘤学程序确定了显微外科头颈部重建病例。感兴趣的结果是30天死亡率。
■术后30天死亡率为1.2%。单变量逻辑回归分析确定了以下关联:年龄>80岁,高血压,功能状态差,术前伤口感染,肾功能不全,营养不良,贫血,和延长的操作时间。使用多变量逻辑回归模型根据营养不良和贫血的程度进一步分层。发现红细胞压积<30%是术后30天死亡率的独立危险因素(比值比[OR]=9.59,置信区间[CI]2.32-39.65,P<.1),白蛋白<3.5g/dL。白蛋白<2.5g/dL时,这种相关性甚至更强(OR=11.64,CI3.06-44.25,P<0.01)。三分之一(36.6%)的患者术前贫血,其中不到1%需要术前输血,虽然四分之一(24.6%)需要术中或术后72小时输血。
■术前贫血是术后30天死亡的危险因素。随着贫血的恶化,这种联系似乎变得更强。术前识别和优化此类患者可以减轻术后30天死亡率的发生率。
OBJECTIVE: To identify the incidence and risk factors for 30-day postoperative mortality after microsurgical head and neck reconstruction following oncological resection.
METHODS: Retrospective case-control study.
METHODS: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
METHODS: Microsurgical head and neck reconstructive cases were identified from 2005 to 2018 using Current Procedural Terminology codes and oncologic procedures using the International Classification of Disease 9 and 10 codes. The outcome of interest was 30-day mortality.
RESULTS: The 30-day postoperative mortality rate was 1.2%. Univariate logistic regression analysis identified the following associations: age >80 years, hypertension, poor functional status, preoperative wound infection, renal insufficiency, malnutrition, anemia, and prolonged operating time. Multivariable logistic regression models were used to stratify further by the degree of malnutrition and anemia. Hematocrit <30% was found to be an independent risk factor for 30-day postoperative mortality (odds ratio [OR] = 9.59, confidence interval [CI] 2.32-39.65, P < .1) with albumin <3.5 g/dL. This association was even stronger with albumin <2.5 g/dL (OR = 11.64, CI 3.06-44.25, P < .01). One-third of patients (36.6%) had preoperative anemia, of which less than 1% required preoperative transfusion, although one-quarter (24.6%) required intraoperative or 72 hours postoperative transfusion.
CONCLUSIONS: Preoperative anemia is a risk factor for 30-day postoperative mortality. This association seems to get stronger with worsening anemia. Identification and optimization of such patients preoperatively may mitigate the incidence of 30-day postoperative mortality.