Association between operation‐ and operator‐related factors and surgical complications among patients undergoing free‐flap reconstruction for head and neck cancers: A propensity score‐matched study of 1,865 free‐flap reconstructions

Objective Efforts have been devoted to clarify the possible factors related to postoperative complications in free‐flap reconstruction. While patient‐related factors have been widely discussed, studies regarding the operation/operator‐related factors are rather limited in the literature. This study was designed to investigate the relationship between operation/operator‐related factors and the surgical complications in free‐flap reconstruction following head and neck cancer resection. Methods Data of 1,841 patients with a total of 1,865 free‐flap reconstructions (24 double free‐flap reconstructions) between March 2008 and February 2017 were retrieved from the registered microsurgery database of the hospital. The association of operation/operator‐related factors (including flap length and length–width ratio, flap types, use of vein graft, opposite side microanastomosis, number of microanastomoses, operators, operator experience, and operation time) with surgical complications was assessed by 1:1 propensity score‐matched study groups. Results After propensity score matching of the patient‐related factors, the rate of vein grafting was significantly higher (0.6% vs. 2.2%, p = .038) and the operation time was longer (7.0 [5.8–8.5] vs. 7.4 [6.1–8.8] hr, p = .006) in the complication group. In addition, flap length and length–width ratio, flap types, opposite side microanastomosis, number of microanastomoses, operators, and operator experience were not associated with surgical complications. Conclusions In a hospital that consisted of surgeons with high‐volume or very‐high‐volume experience, the operators or operation experience were not significantly associated with the surgical complications. Only a longer operation time was associated with surgical complications in the patients who underwent free‐flap reconstruction for head and neck cancer.