The Impact of Metabolic Syndrome on Microvascular Head and Neck Reconstruction: An ACS-NSQIP data analysis

Adriana C Panayi; Valentin Haug; Martin Kauke-Navarro; Yannick F Diehm; Bohdan Pomahac

doi:10.1016/j.bjps.2021.11.074

The Impact of Metabolic Syndrome on Microvascular Head and Neck Reconstruction: An ACS-NSQIP data analysis

J Plast Reconstr Aesthet Surg. 2022 Apr;75(4):1360-1371. doi: 10.1016/j.bjps.2021.11.074. Epub 2021 Nov 29.

Authors

Adriana C Panayi¹, Valentin Haug², Martin Kauke-Navarro¹, Yannick F Diehm², Bohdan Pomahac³

Affiliations

¹ Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, USA.
² Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
³ Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, USA. Electronic address: bpomahac@bwh.harvard.edu.

PMID: 34955390
DOI: 10.1016/j.bjps.2021.11.074

Abstract

Background: Metabolic syndrome (MetS) can predispose patients to poorer surgical outcomes. In this study, we sought to evaluate the impact of MetS on the postoperative outcomes of head and neck microvascular reconstruction.

Methods: Review of the 2015-2019 NSQIP database identified 5,323 cases of microvascular reconstruction, of which 3,809 were head and neck cases. Of the included patients, 184 had MetS and 3625 did not. The groups were compared in terms of demographics and comorbidities. Postoperative outcomes assessed included mortality, average operative time and length of hospital stay, surgical and medical complications, and nonhome discharge.

Results: The MetS group had higher rates of medical complications (p<0.0001), sepsis (p=0.02), septic shock (p=0.01), and skilled care-discharge (p=0.0004). Analysis by flap type revealed that MetS patients receiving free skin flaps experienced higher rates of organ space infection (p=0.02), sepsis (p<0.0001), and lower home-discharge (p=0.01). In the free muscle group, superficial incisional infection (p=0.04), UTI (p=0.02), and septic shock (p=0.01) were higher in MetS patients. Stratification by surgical site showed that the occurrence of sepsis was significantly higher in the patients receiving microvascular flap reconstruction of the larynx (p=0.04) or tongue(p=0.03). Stratification of the MetS patients according to treatment for diabetes showed that patients receiving insulin experienced a higher rate of superficial incisional infection (p=0.04). A multivariate analysis verified significantly higher rates of medical complications (p<0.0001), sepsis (p=0.03) and septic shock (p=0.01) in the MetS group.

Conclusion: Patients with MetS undergoing head and neck microvascular reconstruction are at increased risk of postoperative medical complications, including sepsis and septic shock, and are more likely to be discharged to a skilled care facility. Surgical outcomes were found to depend on the type of flap and site of surgery.

Keywords: Head and neck; Metabolic syndrome; Microvascular; Obesity; Reconstruction.

Published by Elsevier Ltd.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Data Analysis
Free Tissue Flaps* / adverse effects
Free Tissue Flaps* / surgery
Head and Neck Neoplasms* / complications
Head and Neck Neoplasms* / surgery
Humans
Metabolic Syndrome* / complications
Metabolic Syndrome* / surgery
Plastic Surgery Procedures* / adverse effects
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Retrospective Studies
Sepsis* / complications
Sepsis* / epidemiology
Shock, Septic* / complications
Shock, Septic* / surgery