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...
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| Veröffentlicht in: | Microsurgery 2019-09, Vol.39 (6), p.528-534 |
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| creator | Kuo, Spencer C. H. Kuo, Pao‐Jen Yen, Yuan‐Hao Chien, Peng‐Chen Hsieh, Hsiao‐Yun Hsieh, Ching‐Hua |
| description | 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. |
| doi_str_mv | 10.1002/micr.30477 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2292997241</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2291247858</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3577-1f370c979649d6848a53d9283647ffb95e1a89c9a518047fb106321dfcaa92d63</originalsourceid><addsrcrecordid>eNp9ks9u1DAQxi0EokvhwgMgS1wQaor_JLHNbbWitFIREoJz5LXH25TEDnaiam88Qp-RR-AJcLILBw492TPz8-dPM4PQS0rOKSHsXd-aeM5JKcQjtKJEyYKJij1GKyK4LCiR1Ql6ltItIUQpoZ6iE06p5IrQFfq9TimYVo9t8HgL4x2Ax2GAuGR-_bzH2ttjIsQcR-j0CBY7bXIiLeU0xV1rdIdN6Icu3-a3udQHv8NDjsCPCU_eQtyFNudcBMhartMDjmAyPMbJLB5ciPgGtF2EPZjv2GhvIKb3eI2HmJ341I57nEyIs0avR3OT_aRxsnscHKZnsq4e-CE9R0-c7hK8OJ6n6NvFh6-by-L688erzfq6MLwSoqCOC2Jyv-pS2VqWUlfcKiZ5XQrntqoCqqUySldU5t67LSU1Z9Q6o7Vituan6M1BN7v-MUEam75NBrpOewhTahhTLM-DlTSjr_9Db8MUfXY3U5SVQlYyU28PlIkhpQiuGWLb67hvKGnmTWjmTWiWTcjwq6PktO3B_kP_jj4D9ADctR3sH5BqPl1tvhxE_wD4Isj6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2291247858</pqid></control><display><type>article</type><title>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</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Kuo, Spencer C. H. ; Kuo, Pao‐Jen ; Yen, Yuan‐Hao ; Chien, Peng‐Chen ; Hsieh, Hsiao‐Yun ; Hsieh, Ching‐Hua</creator><creatorcontrib>Kuo, Spencer C. H. ; Kuo, Pao‐Jen ; Yen, Yuan‐Hao ; Chien, Peng‐Chen ; Hsieh, Hsiao‐Yun ; Hsieh, Ching‐Hua</creatorcontrib><description>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.</description><identifier>ISSN: 0738-1085</identifier><identifier>EISSN: 1098-2752</identifier><identifier>DOI: 10.1002/micr.30477</identifier><identifier>PMID: 31183901</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Anastomosis, Surgical ; Cancer ; Clinical Competence ; Complications ; Female ; Free Tissue Flaps - blood supply ; Free Tissue Flaps - surgery ; Head & neck cancer ; Humans ; Male ; Medical personnel ; Microsurgery ; Middle Aged ; Neoplasm Staging ; Operative Time ; Otorhinolaryngologic Neoplasms - pathology ; Otorhinolaryngologic Neoplasms - surgery ; Patients ; Postoperative Complications - etiology ; Propensity Score ; Reconstructive Surgical Procedures - methods ; Risk Factors ; Surgery ; Taiwan ; Treatment Outcome ; Veins - transplantation</subject><ispartof>Microsurgery, 2019-09, Vol.39 (6), p.528-534</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3577-1f370c979649d6848a53d9283647ffb95e1a89c9a518047fb106321dfcaa92d63</citedby><cites>FETCH-LOGICAL-c3577-1f370c979649d6848a53d9283647ffb95e1a89c9a518047fb106321dfcaa92d63</cites><orcidid>0000-0002-0945-2746</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fmicr.30477$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fmicr.30477$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27922,27923,45572,45573</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31183901$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kuo, Spencer C. H.</creatorcontrib><creatorcontrib>Kuo, Pao‐Jen</creatorcontrib><creatorcontrib>Yen, Yuan‐Hao</creatorcontrib><creatorcontrib>Chien, Peng‐Chen</creatorcontrib><creatorcontrib>Hsieh, Hsiao‐Yun</creatorcontrib><creatorcontrib>Hsieh, Ching‐Hua</creatorcontrib><title>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</title><title>Microsurgery</title><addtitle>Microsurgery</addtitle><description>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.</description><subject>Anastomosis, Surgical</subject><subject>Cancer</subject><subject>Clinical Competence</subject><subject>Complications</subject><subject>Female</subject><subject>Free Tissue Flaps - blood supply</subject><subject>Free Tissue Flaps - surgery</subject><subject>Head & neck cancer</subject><subject>Humans</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Microsurgery</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Operative Time</subject><subject>Otorhinolaryngologic Neoplasms - pathology</subject><subject>Otorhinolaryngologic Neoplasms - surgery</subject><subject>Patients</subject><subject>Postoperative Complications - etiology</subject><subject>Propensity Score</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Taiwan</subject><subject>Treatment Outcome</subject><subject>Veins - transplantation</subject><issn>0738-1085</issn><issn>1098-2752</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks9u1DAQxi0EokvhwgMgS1wQaor_JLHNbbWitFIREoJz5LXH25TEDnaiam88Qp-RR-AJcLILBw492TPz8-dPM4PQS0rOKSHsXd-aeM5JKcQjtKJEyYKJij1GKyK4LCiR1Ql6ltItIUQpoZ6iE06p5IrQFfq9TimYVo9t8HgL4x2Ax2GAuGR-_bzH2ttjIsQcR-j0CBY7bXIiLeU0xV1rdIdN6Icu3-a3udQHv8NDjsCPCU_eQtyFNudcBMhartMDjmAyPMbJLB5ciPgGtF2EPZjv2GhvIKb3eI2HmJ341I57nEyIs0avR3OT_aRxsnscHKZnsq4e-CE9R0-c7hK8OJ6n6NvFh6-by-L688erzfq6MLwSoqCOC2Jyv-pS2VqWUlfcKiZ5XQrntqoCqqUySldU5t67LSU1Z9Q6o7Vituan6M1BN7v-MUEam75NBrpOewhTahhTLM-DlTSjr_9Db8MUfXY3U5SVQlYyU28PlIkhpQiuGWLb67hvKGnmTWjmTWiWTcjwq6PktO3B_kP_jj4D9ADctR3sH5BqPl1tvhxE_wD4Isj6</recordid><startdate>201909</startdate><enddate>201909</enddate><creator>Kuo, Spencer C. H.</creator><creator>Kuo, Pao‐Jen</creator><creator>Yen, Yuan‐Hao</creator><creator>Chien, Peng‐Chen</creator><creator>Hsieh, Hsiao‐Yun</creator><creator>Hsieh, Ching‐Hua</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7T7</scope><scope>7TK</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0945-2746</orcidid></search><sort><creationdate>201909</creationdate><title>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</title><author>Kuo, Spencer C. H. ; Kuo, Pao‐Jen ; Yen, Yuan‐Hao ; Chien, Peng‐Chen ; Hsieh, Hsiao‐Yun ; Hsieh, Ching‐Hua</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3577-1f370c979649d6848a53d9283647ffb95e1a89c9a518047fb106321dfcaa92d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Anastomosis, Surgical</topic><topic>Cancer</topic><topic>Clinical Competence</topic><topic>Complications</topic><topic>Female</topic><topic>Free Tissue Flaps - blood supply</topic><topic>Free Tissue Flaps - surgery</topic><topic>Head & neck cancer</topic><topic>Humans</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Microsurgery</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Operative Time</topic><topic>Otorhinolaryngologic Neoplasms - pathology</topic><topic>Otorhinolaryngologic Neoplasms - surgery</topic><topic>Patients</topic><topic>Postoperative Complications - etiology</topic><topic>Propensity Score</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Taiwan</topic><topic>Treatment Outcome</topic><topic>Veins - transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kuo, Spencer C. H.</creatorcontrib><creatorcontrib>Kuo, Pao‐Jen</creatorcontrib><creatorcontrib>Yen, Yuan‐Hao</creatorcontrib><creatorcontrib>Chien, Peng‐Chen</creatorcontrib><creatorcontrib>Hsieh, Hsiao‐Yun</creatorcontrib><creatorcontrib>Hsieh, Ching‐Hua</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Microsurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kuo, Spencer C. H.</au><au>Kuo, Pao‐Jen</au><au>Yen, Yuan‐Hao</au><au>Chien, Peng‐Chen</au><au>Hsieh, Hsiao‐Yun</au><au>Hsieh, Ching‐Hua</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Microsurgery</jtitle><addtitle>Microsurgery</addtitle><date>2019-09</date><risdate>2019</risdate><volume>39</volume><issue>6</issue><spage>528</spage><epage>534</epage><pages>528-534</pages><issn>0738-1085</issn><eissn>1098-2752</eissn><abstract>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.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>31183901</pmid><doi>10.1002/micr.30477</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0945-2746</orcidid></addata></record> |
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| ispartof | Microsurgery, 2019-09, Vol.39 (6), p.528-534 |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Anastomosis, Surgical Cancer Clinical Competence Complications Female Free Tissue Flaps - blood supply Free Tissue Flaps - surgery Head & neck cancer Humans Male Medical personnel Microsurgery Middle Aged Neoplasm Staging Operative Time Otorhinolaryngologic Neoplasms - pathology Otorhinolaryngologic Neoplasms - surgery Patients Postoperative Complications - etiology Propensity Score Reconstructive Surgical Procedures - methods Risk Factors Surgery Taiwan Treatment Outcome Veins - transplantation |
| title | 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 |
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