Clinical Predictors of Postoperative Complications Following Head and Neck Free Flap Reconstruction
ASA Poster Gallery. Sacks B. 10/11/25; 4177973; A1265
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Type: Outcomes and Database Research I - ePosters Monitor 24
Topic: Outcomes and Database Research
Brittany Sacks, BS1, Amir Taree, MD2, Adam Levine, MD2, Samuel DeMaria, MD2.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Introduction:
Head and neck free flap reconstruction carries a high risk of postoperative complications, including infection and reoperation. While several clinical factors are thought to influence outcomes, the strength and independence of these associations-especially when accounting for covariates like body mass index (BMI) and American Society of Anesthesiologists (ASA) classification-remain unclear. Identifying modifiable predictors of complications could guide risk stratification, patient selection, and perioperative care. This study examines the association between smoking status, BMI, and hemoglobin with surgical site infection (SSI), complication risk, and return to the operating room (OR), using both unadjusted and covariate-adjusted models.
Methods:
A retrospective cohort study was conducted using a surgical outcomes database of patients undergoing head and neck free flap reconstruction at a single center. Logistic regression was used to evaluate associations between individual predictors (smoking, BMI, preoperative hemoglobin) and binary outcomes (SSI, complication status). Complication severity, categorized using a modified Clavien-Dindo classification, was analyzed in relation to return to the OR using multinomial logistic regression. Each analysis was conducted with both unadjusted and adjusted models for BMI and ASA. Patients with missing or excluded data in any relevant columns were removed from the analysis on a per-model basis. Statistical significance was defined as p < 0.05.
Results:
Among the patients evaluated, increasing complication severity was significantly associated with higher odds of reoperation in both unadjusted (p < 0.001) and covariate-adjusted models (p < 0.001). In the BMI analysis, increased BMI was significantly associated with higher odds of SSI in both unadjusted (p = 0.004) and adjusted models (p = 0.006). Smoking status showed a borderline protective association with SSI in the unadjusted analysis (p = 0.060), which was no longer significant after adjusting for BMI (p = 0.112). Preoperative hemoglobin was not significantly associated with complication risk in any model (Table 1).
Conclusion:
BMI emerged as a consistent preoperative predictor of SSI in head and neck flap reconstruction, which indicates it may be useful for patient selection and highlights the importance of preoperative optimization in this population. Complication severity was strongly associated with return to the operating room, reinforcing the need for close postoperative monitoring. Preoperative hemoglobin was not predictive of complications and may have limited utility for risk assessment in this setting. Further research should evaluate how perioperative management strategies might influence outcomes in higher-risk patients.
Topic: Outcomes and Database Research
Brittany Sacks, BS1, Amir Taree, MD2, Adam Levine, MD2, Samuel DeMaria, MD2.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Introduction:
Head and neck free flap reconstruction carries a high risk of postoperative complications, including infection and reoperation. While several clinical factors are thought to influence outcomes, the strength and independence of these associations-especially when accounting for covariates like body mass index (BMI) and American Society of Anesthesiologists (ASA) classification-remain unclear. Identifying modifiable predictors of complications could guide risk stratification, patient selection, and perioperative care. This study examines the association between smoking status, BMI, and hemoglobin with surgical site infection (SSI), complication risk, and return to the operating room (OR), using both unadjusted and covariate-adjusted models.
Methods:
A retrospective cohort study was conducted using a surgical outcomes database of patients undergoing head and neck free flap reconstruction at a single center. Logistic regression was used to evaluate associations between individual predictors (smoking, BMI, preoperative hemoglobin) and binary outcomes (SSI, complication status). Complication severity, categorized using a modified Clavien-Dindo classification, was analyzed in relation to return to the OR using multinomial logistic regression. Each analysis was conducted with both unadjusted and adjusted models for BMI and ASA. Patients with missing or excluded data in any relevant columns were removed from the analysis on a per-model basis. Statistical significance was defined as p < 0.05.
Results:
Among the patients evaluated, increasing complication severity was significantly associated with higher odds of reoperation in both unadjusted (p < 0.001) and covariate-adjusted models (p < 0.001). In the BMI analysis, increased BMI was significantly associated with higher odds of SSI in both unadjusted (p = 0.004) and adjusted models (p = 0.006). Smoking status showed a borderline protective association with SSI in the unadjusted analysis (p = 0.060), which was no longer significant after adjusting for BMI (p = 0.112). Preoperative hemoglobin was not significantly associated with complication risk in any model (Table 1).
Conclusion:
BMI emerged as a consistent preoperative predictor of SSI in head and neck flap reconstruction, which indicates it may be useful for patient selection and highlights the importance of preoperative optimization in this population. Complication severity was strongly associated with return to the operating room, reinforcing the need for close postoperative monitoring. Preoperative hemoglobin was not predictive of complications and may have limited utility for risk assessment in this setting. Further research should evaluate how perioperative management strategies might influence outcomes in higher-risk patients.
Type: Outcomes and Database Research I - ePosters Monitor 24
Topic: Outcomes and Database Research
Brittany Sacks, BS1, Amir Taree, MD2, Adam Levine, MD2, Samuel DeMaria, MD2.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Introduction:
Head and neck free flap reconstruction carries a high risk of postoperative complications, including infection and reoperation. While several clinical factors are thought to influence outcomes, the strength and independence of these associations-especially when accounting for covariates like body mass index (BMI) and American Society of Anesthesiologists (ASA) classification-remain unclear. Identifying modifiable predictors of complications could guide risk stratification, patient selection, and perioperative care. This study examines the association between smoking status, BMI, and hemoglobin with surgical site infection (SSI), complication risk, and return to the operating room (OR), using both unadjusted and covariate-adjusted models.
Methods:
A retrospective cohort study was conducted using a surgical outcomes database of patients undergoing head and neck free flap reconstruction at a single center. Logistic regression was used to evaluate associations between individual predictors (smoking, BMI, preoperative hemoglobin) and binary outcomes (SSI, complication status). Complication severity, categorized using a modified Clavien-Dindo classification, was analyzed in relation to return to the OR using multinomial logistic regression. Each analysis was conducted with both unadjusted and adjusted models for BMI and ASA. Patients with missing or excluded data in any relevant columns were removed from the analysis on a per-model basis. Statistical significance was defined as p < 0.05.
Results:
Among the patients evaluated, increasing complication severity was significantly associated with higher odds of reoperation in both unadjusted (p < 0.001) and covariate-adjusted models (p < 0.001). In the BMI analysis, increased BMI was significantly associated with higher odds of SSI in both unadjusted (p = 0.004) and adjusted models (p = 0.006). Smoking status showed a borderline protective association with SSI in the unadjusted analysis (p = 0.060), which was no longer significant after adjusting for BMI (p = 0.112). Preoperative hemoglobin was not significantly associated with complication risk in any model (Table 1).
Conclusion:
BMI emerged as a consistent preoperative predictor of SSI in head and neck flap reconstruction, which indicates it may be useful for patient selection and highlights the importance of preoperative optimization in this population. Complication severity was strongly associated with return to the operating room, reinforcing the need for close postoperative monitoring. Preoperative hemoglobin was not predictive of complications and may have limited utility for risk assessment in this setting. Further research should evaluate how perioperative management strategies might influence outcomes in higher-risk patients.
Topic: Outcomes and Database Research
Brittany Sacks, BS1, Amir Taree, MD2, Adam Levine, MD2, Samuel DeMaria, MD2.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Introduction:
Head and neck free flap reconstruction carries a high risk of postoperative complications, including infection and reoperation. While several clinical factors are thought to influence outcomes, the strength and independence of these associations-especially when accounting for covariates like body mass index (BMI) and American Society of Anesthesiologists (ASA) classification-remain unclear. Identifying modifiable predictors of complications could guide risk stratification, patient selection, and perioperative care. This study examines the association between smoking status, BMI, and hemoglobin with surgical site infection (SSI), complication risk, and return to the operating room (OR), using both unadjusted and covariate-adjusted models.
Methods:
A retrospective cohort study was conducted using a surgical outcomes database of patients undergoing head and neck free flap reconstruction at a single center. Logistic regression was used to evaluate associations between individual predictors (smoking, BMI, preoperative hemoglobin) and binary outcomes (SSI, complication status). Complication severity, categorized using a modified Clavien-Dindo classification, was analyzed in relation to return to the OR using multinomial logistic regression. Each analysis was conducted with both unadjusted and adjusted models for BMI and ASA. Patients with missing or excluded data in any relevant columns were removed from the analysis on a per-model basis. Statistical significance was defined as p < 0.05.
Results:
Among the patients evaluated, increasing complication severity was significantly associated with higher odds of reoperation in both unadjusted (p < 0.001) and covariate-adjusted models (p < 0.001). In the BMI analysis, increased BMI was significantly associated with higher odds of SSI in both unadjusted (p = 0.004) and adjusted models (p = 0.006). Smoking status showed a borderline protective association with SSI in the unadjusted analysis (p = 0.060), which was no longer significant after adjusting for BMI (p = 0.112). Preoperative hemoglobin was not significantly associated with complication risk in any model (Table 1).
Conclusion:
BMI emerged as a consistent preoperative predictor of SSI in head and neck flap reconstruction, which indicates it may be useful for patient selection and highlights the importance of preoperative optimization in this population. Complication severity was strongly associated with return to the operating room, reinforcing the need for close postoperative monitoring. Preoperative hemoglobin was not predictive of complications and may have limited utility for risk assessment in this setting. Further research should evaluate how perioperative management strategies might influence outcomes in higher-risk patients.
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