The Impact of Metabolic Syndrome on Microvascular Head and Neck Reconstruction: An ACS-NSQIP data analysis
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. Review of the 2015–2019 NSQIP database identified 5,323 cases of microvascular reconstru...
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| Veröffentlicht in: | Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2022-04, Vol.75 (4), p.1360-1371 |
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| container_title | Journal of plastic, reconstructive & aesthetic surgery |
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| creator | Panayi, Adriana C. Haug, Valentin Kauke-Navarro, Martin Diehm, Yannick F. Pomahac, Bohdan |
| description | 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.
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.
The MetS group had higher rates of medical complications (p |
| doi_str_mv | 10.1016/j.bjps.2021.11.074 |
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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.
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.
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.</description><identifier>ISSN: 1748-6815</identifier><identifier>EISSN: 1878-0539</identifier><identifier>DOI: 10.1016/j.bjps.2021.11.074</identifier><identifier>PMID: 34955390</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Data Analysis ; Free Tissue Flaps - adverse effects ; Free Tissue Flaps - surgery ; Head and neck ; Head and Neck Neoplasms - complications ; Head and Neck Neoplasms - surgery ; Humans ; Metabolic syndrome ; Metabolic Syndrome - complications ; Metabolic Syndrome - surgery ; Microvascular ; Obesity ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - surgery ; Reconstruction ; Reconstructive Surgical Procedures - adverse effects ; Retrospective Studies ; Sepsis - complications ; Sepsis - epidemiology ; Shock, Septic - complications ; Shock, Septic - surgery</subject><ispartof>Journal of plastic, reconstructive & aesthetic surgery, 2022-04, Vol.75 (4), p.1360-1371</ispartof><rights>2021</rights><rights>Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-6ceb9611f0a7846b8199bee54da0224e2040b8bb927a13df10090e2b2d0a12af3</citedby><cites>FETCH-LOGICAL-c356t-6ceb9611f0a7846b8199bee54da0224e2040b8bb927a13df10090e2b2d0a12af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1748681521006185$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34955390$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Panayi, Adriana C.</creatorcontrib><creatorcontrib>Haug, Valentin</creatorcontrib><creatorcontrib>Kauke-Navarro, Martin</creatorcontrib><creatorcontrib>Diehm, Yannick F.</creatorcontrib><creatorcontrib>Pomahac, Bohdan</creatorcontrib><title>The Impact of Metabolic Syndrome on Microvascular Head and Neck Reconstruction: An ACS-NSQIP data analysis</title><title>Journal of plastic, reconstructive & aesthetic surgery</title><addtitle>J Plast Reconstr Aesthet Surg</addtitle><description>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.
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.
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.
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.</description><subject>Data Analysis</subject><subject>Free Tissue Flaps - adverse effects</subject><subject>Free Tissue Flaps - surgery</subject><subject>Head and neck</subject><subject>Head and Neck Neoplasms - complications</subject><subject>Head and Neck Neoplasms - surgery</subject><subject>Humans</subject><subject>Metabolic syndrome</subject><subject>Metabolic Syndrome - complications</subject><subject>Metabolic Syndrome - surgery</subject><subject>Microvascular</subject><subject>Obesity</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - surgery</subject><subject>Reconstruction</subject><subject>Reconstructive Surgical Procedures - adverse effects</subject><subject>Retrospective Studies</subject><subject>Sepsis - complications</subject><subject>Sepsis - epidemiology</subject><subject>Shock, Septic - complications</subject><subject>Shock, Septic - surgery</subject><issn>1748-6815</issn><issn>1878-0539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtv1DAUhS1ERUvhD7CovGST1NdxXlU3oxHQkfoApqwtP26E0yQe7KTS_Hs8mpYlq3sX3znS-Qj5BCwHBtVln-t-F3POOOQAOavFG3IGTd1krCzat-mvRZNVDZSn5H2MPWOiAFG-I6eFaMuEsDPSP_5Guhl3yszUd_QOZ6X94Azd7icb_IjUT_TOmeCfVTTLoAK9QWWpmiy9R_NEf6LxU5zDYmbnpyu6muhqvc3utz8236lVs0qoGvbRxQ_kpFNDxI8v95z8-vrlcX2T3T5826xXt5kpymrOKoO6rQA6pupGVLqBttWIpbCKcS6QM8F0o3XLawWF7YCxliHX3DIFXHXFOfl87N0F_2fBOMvRRYPDoCb0S5S8AlGXNTQ8ofyIpn0xBuzkLrhRhb0EJg-OZS8PjuXBsQSQyXEKXbz0L3pE-y_yKjUB10cA08pnh0FG43AyaF1AM0vr3f_6_wJNw4x3</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Panayi, Adriana C.</creator><creator>Haug, Valentin</creator><creator>Kauke-Navarro, Martin</creator><creator>Diehm, Yannick F.</creator><creator>Pomahac, Bohdan</creator><general>Elsevier Ltd</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>7X8</scope></search><sort><creationdate>20220401</creationdate><title>The Impact of Metabolic Syndrome on Microvascular Head and Neck Reconstruction: An ACS-NSQIP data analysis</title><author>Panayi, Adriana C. ; Haug, Valentin ; Kauke-Navarro, Martin ; Diehm, Yannick F. ; Pomahac, Bohdan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-6ceb9611f0a7846b8199bee54da0224e2040b8bb927a13df10090e2b2d0a12af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Data Analysis</topic><topic>Free Tissue Flaps - adverse effects</topic><topic>Free Tissue Flaps - surgery</topic><topic>Head and neck</topic><topic>Head and Neck Neoplasms - complications</topic><topic>Head and Neck Neoplasms - surgery</topic><topic>Humans</topic><topic>Metabolic syndrome</topic><topic>Metabolic Syndrome - complications</topic><topic>Metabolic Syndrome - surgery</topic><topic>Microvascular</topic><topic>Obesity</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - surgery</topic><topic>Reconstruction</topic><topic>Reconstructive Surgical Procedures - adverse effects</topic><topic>Retrospective Studies</topic><topic>Sepsis - complications</topic><topic>Sepsis - epidemiology</topic><topic>Shock, Septic - complications</topic><topic>Shock, Septic - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Panayi, Adriana C.</creatorcontrib><creatorcontrib>Haug, Valentin</creatorcontrib><creatorcontrib>Kauke-Navarro, Martin</creatorcontrib><creatorcontrib>Diehm, Yannick F.</creatorcontrib><creatorcontrib>Pomahac, Bohdan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Panayi, Adriana C.</au><au>Haug, Valentin</au><au>Kauke-Navarro, Martin</au><au>Diehm, Yannick F.</au><au>Pomahac, Bohdan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Impact of Metabolic Syndrome on Microvascular Head and Neck Reconstruction: An ACS-NSQIP data analysis</atitle><jtitle>Journal of plastic, reconstructive & aesthetic surgery</jtitle><addtitle>J Plast Reconstr Aesthet Surg</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>75</volume><issue>4</issue><spage>1360</spage><epage>1371</epage><pages>1360-1371</pages><issn>1748-6815</issn><eissn>1878-0539</eissn><abstract>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.
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.
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.
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.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>34955390</pmid><doi>10.1016/j.bjps.2021.11.074</doi><tpages>12</tpages></addata></record> |
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| subjects | Data Analysis Free Tissue Flaps - adverse effects Free Tissue Flaps - surgery Head and neck Head and Neck Neoplasms - complications Head and Neck Neoplasms - surgery Humans Metabolic syndrome Metabolic Syndrome - complications Metabolic Syndrome - surgery Microvascular Obesity Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - surgery Reconstruction Reconstructive Surgical Procedures - adverse effects Retrospective Studies Sepsis - complications Sepsis - epidemiology Shock, Septic - complications Shock, Septic - surgery |
| title | The Impact of Metabolic Syndrome on Microvascular Head and Neck Reconstruction: An ACS-NSQIP data analysis |
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