Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients
Objective To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and secondarily determine increased risk for postoperative complicatio...
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| Veröffentlicht in: | The Laryngoscope 2024-02, Vol.134 (2), p.688-694 |
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| creator | Oglesby, Kacie R. Jefferson, Gina D. Thomas, Carissa M. Tomblin, Caitlyn Alnemri, Angela Curry, Joseph M. Bonaventure, Caroline Sweeny, Larissa Richards, Holden W. Wax, Mark Kane, Anne C. |
| description | Objective
To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and secondarily determine increased risk for postoperative complications.
Methods
Retrospective chart review was performed at five tertiary care centers. Patients were identified that had undergone microvascular free flap reconstruction of the head and neck with diagnosis of renal failure, classified as Stage 3 CKD or higher. Demographic data was collected. Outcomes in the postoperative period were examined.
Results
Seventy‐three patients met inclusion criteria. The average patient age was 69 years with a male predominance (n = 48). The majority of patients had CKD Stage 3 (n = 52). Overall flap failure rate was 12.33% (n = 9, CKD stage 3 = 7.69%, CKD stage 4 = 30%, CKD stage 5 = 18%). There was an increased risk of flap failure on multivariate analysis for CKD stage 4/5 patients when compared to CKD 3 patients (p = 0.0095). When compared to matched controls, there was an increased risk of flap failure in CKD patients (p = 0.01) as well as an increased risk of overall complications (p |
| doi_str_mv | 10.1002/lary.30862 |
| format | Article |
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To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and secondarily determine increased risk for postoperative complications.
Methods
Retrospective chart review was performed at five tertiary care centers. Patients were identified that had undergone microvascular free flap reconstruction of the head and neck with diagnosis of renal failure, classified as Stage 3 CKD or higher. Demographic data was collected. Outcomes in the postoperative period were examined.
Results
Seventy‐three patients met inclusion criteria. The average patient age was 69 years with a male predominance (n = 48). The majority of patients had CKD Stage 3 (n = 52). Overall flap failure rate was 12.33% (n = 9, CKD stage 3 = 7.69%, CKD stage 4 = 30%, CKD stage 5 = 18%). There was an increased risk of flap failure on multivariate analysis for CKD stage 4/5 patients when compared to CKD 3 patients (p = 0.0095). When compared to matched controls, there was an increased risk of flap failure in CKD patients (p = 0.01) as well as an increased risk of overall complications (p < 0.0001).
Conclusions
Patients with CKD undergoing head and neck reconstruction are at a higher risk of flap failure and overall complications. When comparing CKD stages there may be increased risk of flap failure in later stages of CKD compared to CKD 3. Appropriate patient counseling is recommended pre‐operatively in this patient population with consideration for regional flaps in the appropriate patient.
Level of Evidence
3 Laryngoscope, 134:688–694, 2024</description><identifier>ISSN: 0023-852X</identifier><identifier>ISSN: 1531-4995</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.30862</identifier><identifier>PMID: 37449944</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged ; Female ; Free Tissue Flaps - blood supply ; head and neck ; Head and Neck Neoplasms - complications ; Head and Neck Neoplasms - surgery ; Humans ; Male ; microvascular reconstruction ; Neck - surgery ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; renal failure ; Renal Insufficiency - complications ; Renal Insufficiency, Chronic - complications ; Retrospective Studies</subject><ispartof>The Laryngoscope, 2024-02, Vol.134 (2), p.688-694</ispartof><rights>2023 The American Laryngological, Rhinological and Otological Society, Inc.</rights><rights>2024 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3572-f42f4a7cbf26cdef800cd2c8a369738398a35b0a8c3f1d86297d4783b84239fc3</citedby><cites>FETCH-LOGICAL-c3572-f42f4a7cbf26cdef800cd2c8a369738398a35b0a8c3f1d86297d4783b84239fc3</cites><orcidid>0000-0001-8600-0746 ; 0000-0003-1174-9028 ; 0000-0002-9877-5159</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%2Flary.30862$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.30862$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37449944$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oglesby, Kacie R.</creatorcontrib><creatorcontrib>Jefferson, Gina D.</creatorcontrib><creatorcontrib>Thomas, Carissa M.</creatorcontrib><creatorcontrib>Tomblin, Caitlyn</creatorcontrib><creatorcontrib>Alnemri, Angela</creatorcontrib><creatorcontrib>Curry, Joseph M.</creatorcontrib><creatorcontrib>Bonaventure, Caroline</creatorcontrib><creatorcontrib>Sweeny, Larissa</creatorcontrib><creatorcontrib>Richards, Holden W.</creatorcontrib><creatorcontrib>Wax, Mark</creatorcontrib><creatorcontrib>Kane, Anne C.</creatorcontrib><title>Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients</title><title>The Laryngoscope</title><addtitle>Laryngoscope</addtitle><description>Objective
To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and secondarily determine increased risk for postoperative complications.
Methods
Retrospective chart review was performed at five tertiary care centers. Patients were identified that had undergone microvascular free flap reconstruction of the head and neck with diagnosis of renal failure, classified as Stage 3 CKD or higher. Demographic data was collected. Outcomes in the postoperative period were examined.
Results
Seventy‐three patients met inclusion criteria. The average patient age was 69 years with a male predominance (n = 48). The majority of patients had CKD Stage 3 (n = 52). Overall flap failure rate was 12.33% (n = 9, CKD stage 3 = 7.69%, CKD stage 4 = 30%, CKD stage 5 = 18%). There was an increased risk of flap failure on multivariate analysis for CKD stage 4/5 patients when compared to CKD 3 patients (p = 0.0095). When compared to matched controls, there was an increased risk of flap failure in CKD patients (p = 0.01) as well as an increased risk of overall complications (p < 0.0001).
Conclusions
Patients with CKD undergoing head and neck reconstruction are at a higher risk of flap failure and overall complications. When comparing CKD stages there may be increased risk of flap failure in later stages of CKD compared to CKD 3. Appropriate patient counseling is recommended pre‐operatively in this patient population with consideration for regional flaps in the appropriate patient.
Level of Evidence
3 Laryngoscope, 134:688–694, 2024</description><subject>Aged</subject><subject>Female</subject><subject>Free Tissue Flaps - blood supply</subject><subject>head and neck</subject><subject>Head and Neck Neoplasms - complications</subject><subject>Head and Neck Neoplasms - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>microvascular reconstruction</subject><subject>Neck - surgery</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>renal failure</subject><subject>Renal Insufficiency - complications</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Retrospective Studies</subject><issn>0023-852X</issn><issn>1531-4995</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90M1KAzEUBeAgiq3VjQ8gATciTM1vk1mWYq1QrJQKuhrSzA1Mnc7UZAbp25va6sKFqxu4H4fcg9AlJX1KCLsrjd_2OdEDdoS6VHKaiDSVx6gblzzRkr120FkIK0Ko4pKcog5XIhIhumgyaxtbryHg2uEJmBybKsdPYN_x2APgRRFCG4c3VXDgcVHhOVSmxGNTlK0H_GyaAqomnKMTZ8oAF4fZQy_j-8VokkxnD4-j4TSxXCqWOMGcMMouHRvYHJwmxObMasMHqeKap_Ell8Royx3N40mpyoXSfKkF46mzvIdu9rkbX3-0EJpsXQQLZWkqqNuQMc01k0QpFun1H7qqWx8_H1VKpZCCEhrV7V5ZX4fgwWUbX6xjpRkl2a7fbNdv9t1vxFeHyHa5hvyX_hQaAd2Dz6KE7T9R2XQ4f9uHfgGsT4Nc</recordid><startdate>202402</startdate><enddate>202402</enddate><creator>Oglesby, Kacie R.</creator><creator>Jefferson, Gina D.</creator><creator>Thomas, Carissa M.</creator><creator>Tomblin, Caitlyn</creator><creator>Alnemri, Angela</creator><creator>Curry, Joseph M.</creator><creator>Bonaventure, Caroline</creator><creator>Sweeny, Larissa</creator><creator>Richards, Holden W.</creator><creator>Wax, Mark</creator><creator>Kane, Anne C.</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>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8600-0746</orcidid><orcidid>https://orcid.org/0000-0003-1174-9028</orcidid><orcidid>https://orcid.org/0000-0002-9877-5159</orcidid></search><sort><creationdate>202402</creationdate><title>Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients</title><author>Oglesby, Kacie R. ; Jefferson, Gina D. ; Thomas, Carissa M. ; Tomblin, Caitlyn ; Alnemri, Angela ; Curry, Joseph M. ; Bonaventure, Caroline ; Sweeny, Larissa ; Richards, Holden W. ; Wax, Mark ; Kane, Anne C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3572-f42f4a7cbf26cdef800cd2c8a369738398a35b0a8c3f1d86297d4783b84239fc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Female</topic><topic>Free Tissue Flaps - blood supply</topic><topic>head and neck</topic><topic>Head and Neck Neoplasms - complications</topic><topic>Head and Neck Neoplasms - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>microvascular reconstruction</topic><topic>Neck - surgery</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>renal failure</topic><topic>Renal Insufficiency - complications</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oglesby, Kacie R.</creatorcontrib><creatorcontrib>Jefferson, Gina D.</creatorcontrib><creatorcontrib>Thomas, Carissa M.</creatorcontrib><creatorcontrib>Tomblin, Caitlyn</creatorcontrib><creatorcontrib>Alnemri, Angela</creatorcontrib><creatorcontrib>Curry, Joseph M.</creatorcontrib><creatorcontrib>Bonaventure, Caroline</creatorcontrib><creatorcontrib>Sweeny, Larissa</creatorcontrib><creatorcontrib>Richards, Holden W.</creatorcontrib><creatorcontrib>Wax, Mark</creatorcontrib><creatorcontrib>Kane, Anne C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oglesby, Kacie R.</au><au>Jefferson, Gina D.</au><au>Thomas, Carissa M.</au><au>Tomblin, Caitlyn</au><au>Alnemri, Angela</au><au>Curry, Joseph M.</au><au>Bonaventure, Caroline</au><au>Sweeny, Larissa</au><au>Richards, Holden W.</au><au>Wax, Mark</au><au>Kane, Anne C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients</atitle><jtitle>The Laryngoscope</jtitle><addtitle>Laryngoscope</addtitle><date>2024-02</date><risdate>2024</risdate><volume>134</volume><issue>2</issue><spage>688</spage><epage>694</epage><pages>688-694</pages><issn>0023-852X</issn><issn>1531-4995</issn><eissn>1531-4995</eissn><abstract>Objective
To assess if there is increased risk of free flap failure in renal failure patients undergoing head and neck reconstruction. We seek to primarily assess free flap outcomes based on stages of chronic kidney disease (CKD) and secondarily determine increased risk for postoperative complications.
Methods
Retrospective chart review was performed at five tertiary care centers. Patients were identified that had undergone microvascular free flap reconstruction of the head and neck with diagnosis of renal failure, classified as Stage 3 CKD or higher. Demographic data was collected. Outcomes in the postoperative period were examined.
Results
Seventy‐three patients met inclusion criteria. The average patient age was 69 years with a male predominance (n = 48). The majority of patients had CKD Stage 3 (n = 52). Overall flap failure rate was 12.33% (n = 9, CKD stage 3 = 7.69%, CKD stage 4 = 30%, CKD stage 5 = 18%). There was an increased risk of flap failure on multivariate analysis for CKD stage 4/5 patients when compared to CKD 3 patients (p = 0.0095). When compared to matched controls, there was an increased risk of flap failure in CKD patients (p = 0.01) as well as an increased risk of overall complications (p < 0.0001).
Conclusions
Patients with CKD undergoing head and neck reconstruction are at a higher risk of flap failure and overall complications. When comparing CKD stages there may be increased risk of flap failure in later stages of CKD compared to CKD 3. Appropriate patient counseling is recommended pre‐operatively in this patient population with consideration for regional flaps in the appropriate patient.
Level of Evidence
3 Laryngoscope, 134:688–694, 2024</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>37449944</pmid><doi>10.1002/lary.30862</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8600-0746</orcidid><orcidid>https://orcid.org/0000-0003-1174-9028</orcidid><orcidid>https://orcid.org/0000-0002-9877-5159</orcidid></addata></record> |
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| ispartof | The Laryngoscope, 2024-02, Vol.134 (2), p.688-694 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Female Free Tissue Flaps - blood supply head and neck Head and Neck Neoplasms - complications Head and Neck Neoplasms - surgery Humans Male microvascular reconstruction Neck - surgery Patients Postoperative Complications - epidemiology Postoperative Complications - etiology renal failure Renal Insufficiency - complications Renal Insufficiency, Chronic - complications Retrospective Studies |
| title | Outcomes of Head and Neck Free Tissue Transfer in Renal Failure Patients |
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