The incidence and risk factors of free flap complications after head and neck cancer surgery in elderly patients

doi:10.19438/j.cjoms.2025.06.008

Abstract

Abstract: PURPOSE: To explore the independent risk factors for postoperative free flap complications in elderly patients with head and neck cancer, and to provide a basis for preoperative risk stratification and individualized management. METHODS: A total of 1 197 elderly patients (≥60 years old) admitted to Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2014 to December 2022 were retrospectively included. All patients underwent radical resection of head and neck cancer combined with free flap reconstruction under general anesthesia. Univariate analysis was used to screen potential risk factors for flap complications, and multivariate logistic regression analysis was performed to identify independent risk factors. RESULTS: The total incidence of postoperative free flap complications was 20.13% (241/1 197). Multivariate logistic regression showed that smoking (OR=1.391, 95%CI: 1.008-1.921, P=0.045), chronic obstructive pulmonary disease (COPD) (OR=1.912, 95%CI: 1.064-3.436, P=0.030), malnutrition [prognostic nutritional index(PNI) ≤47.81, OR=1.362, 95%CI: 1.009-1.838, P=0.043], chronic heart failure (OR=1.988, 95%CI: 1.150-3.437, P=0.014), and prolonged operation duration (OR=1.123, 95%CI: 1.052-1.200, P<0.001) were independent risk factors for postoperative flap complications. CONCLUSIONS: Smoking, COPD, malnutrition, chronic heart failure, and prolonged operation duration are independent risk factors for postoperative free flap complications in elderly patients with head and neck cancer. Clinically, targeted preoperative interventions (such as smoking cessation, nutritional support, and control of underlying diseases) and intraoperative time management should be strengthened to reduce the risk of complications.

Key words: Head and neck cancer, Free flap reconstruction, Postoperative complications, Independent risk factors, Elderly patients

CLC Number:

R739.8

Shen Long, Gong Chengxia, Dong Jiegang, Yang Yuelai, Sun Yu, Meng Lu, Zhao Kanru. The incidence and risk factors of free flap complications after head and neck cancer surgery in elderly patients[J]. China Journal of Oral and Maxillofacial Surgery, 2025, 23(6): 586-591.

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