The Role of Intraoperative and Early Postoperative Blood Pressure Variations, Fluid Balance and Inotropics in Fibula Free Flap Head and Neck Reconstruction: A Retrospective Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection and Outcomes
2.3. Surgical Procedure
2.4. Measurement and Definition of Intraoperative Blood Pressure Lability and Hypotension
2.5. Perioperative Management
2.6. Statistical Analysis
3. Results
3.1. Population
3.2. Complications
3.3. Intraoperative Hypotension
3.4. Dobutamine
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Reference | Flap Revision | Flap Revision | p-Value | |
---|---|---|---|---|
All | No | Yes | ||
n, (%) | n, (%) | n, (%) | ||
Age, mean (SD), y | 61.8 (55.3–67) | 64 (55.8–68.4) | 58 (55.3–64.1) | 0.6 |
Sex | ||||
Female | 16 (34.8) | 14 (38.9) | 2 (20) | 0.278 |
Male | 30 (55.2) | 22 (51.1) | 8 (80) | |
Alcohol use (yes) | 24 (52.2) | 17 (47.2) | 7 (70) | 0.211 |
Tobacco use (yes) | 143 (77.7) | 23 (63.9) | 7 (70) | 0.72 |
Arterial hypertension (yes) | 15 (32.6) | 11 (30.6) | 4 (40) | 0.574 |
Chronic obstructive pulmonary disease (yes) | 7 (15.2) | 5 (13.9) | 2 (20) | 0.636 |
Coronary heart disease (yes) | 3 (6.5%) | 2 (5.6) | 1 (10) | 0.62 |
Diabetes (yes) | 3 (6.5%) | 2 (5.6) | 1 (10) | 0.62 |
Weight (SD), kg | 68.1 (61–80.4) | 66.8 (59.5–79.2) | 77 (68–83) | 0.217 |
Preoperative radiotherapy (yes) | 31 (67.4) | 23 (63.9) | 8 (80) | 0.345 |
Renal insufficiency (yes) | 2 (4.3) | 1 (2.8) | 1 (10) | 0.353 |
Length of hospital stay (days) | 16.5 (13–20) | 16 (13–20) | 18 (14–29) | 0.057 |
Duration of surgery (min) | 611.5 (540–720) | 602 (538–682) | 631 (589–743) | 0.437 |
Intraoperative fluid balance (mL) | 3726.5 (3130–4731) | 3692 (3101–4388) | 4859 (3555–6216) | 0.026 |
Intraoperative fluid IV (mL) | 5988 (4774–7280.6) | 5953 (4766–7077) | 6902 (5469–8516) | 0.19 |
Intraoperative blood loss (mL) | 675 (500–1000) | 700 (475–1000) | 631 (500–1000) | 0.628 |
Vasopressor use | ||||
Norepinephrine (total in µg) | 375.5 (0–857) | 375.5 (0–989) | 312.5 (77–641) | 0.493 |
Dobutamine (total in mg) | 37 (0–59) | 27.5 (0–47.5) | 62 (38–109) | 0.019 |
Postoperative nadir hemoglobin (total in g/L) | 93 (85–100) | 94 (85–100) | 89.5 (85–100) | 0.632 |
Intraoperative hypotension | ||||
MAP < 70 mmHg (min) | 342.5 (246–448) | 342.5 (252–444) | 349 (174–552) | 0.79 |
MAP < 65 mmHg (min) | 165.5 (73–273) | 165.5 (67–265) | 152.5 (73–291) | 0.865 |
MAP < 60 mmHg (min) | 40.5 (12–80) | 39 (10.5–78) | 54.5 (18–97) | 0.803 |
MAP < 55 mmHg (min) | 7.5 (2 –15) | 8 (2–15) | 6.5 (2–15) | 0.937 |
Reference | Systemic Complications | Systemic Complications | p-Value | |
---|---|---|---|---|
All | No | Yes | ||
n, (%) | n, (%) | n, (%) | ||
Age, mean (SD), y | 61.8 (55.3–67) | 61.8 (53.5–65.7) | 66.2 (59–73.8) | 0.6 |
Sex | ||||
Female | 16 (34.8) | 12 (38.7) | 4 (26.7) | 0.424 |
Male | 30 (55.2) | 24 (61.3) | 6 (73.3) | |
Alcohol use (yes) | 24 (52.2) | 16 (51.6) | 8 (53.3) | 0.913 |
Tobacco use (yes) | 143 (77.7) | 22 (71) | 8 (53.3) | 0.243 |
Arterial hypertension (yes) | 15 (32.6) | 10 (32.3) | 5 (33.3) | 0.942 |
Chronic obstructive pulmonary disease (yes) | 7 (15.2) | 4 (12.9) | 3 (20) | 0.533 |
Coronary heart disease (yes) | 3 (6.5%) | 1 (3.2) | 2 (13.3) | 0.228 |
Diabetes (yes) | 3 (6.5%) | 2 (6.5) | 1 (6.7) | 0.978 |
Weight (SD), kg | 68.1 (61–80.4) | 68.1 (57.3–79.3) | 68 (64.3–82.5) | 0.289 |
Preoperative radiotherapy (yes) | 31 (67.4) | 23 (74.2) | 8 (53.3) | 0.163 |
Renal insufficiency (yes) | 2 (4.3) | 0 (0) | 2 (13.3) | 1 |
Length of hospital stay (days) | 16.5 (13–20) | 16 (13–20) | 18 (15–26.5) | 0.073 |
Duration of surgery (min) | 611.5 (540–720) | 607 (536.3–674.8) | 619 (560.3–726) | 0.541 |
Intraoperative fluid balance (mL) | 3726.5 (3130–4731) | 3741 (3087–4660) | 3683 (3434–4652) | 0.585 |
Intraoperative fluid IV (mL) | 5988 (4774–7280.6) | 5829 (4796–7318) | 6902 (4792–7250) | 0.452 |
Intraoperative blood loss (mL) | 675 (500–1000) | 700 (500–1000) | 600 (500–1025) | 0.628 |
Vasopressor use | ||||
Norepinephrine (total in µg) | 375.5 (0–857) | 349 (0–818.3) | 428 (103.3–883) | 0.668 |
Dobutamine (total in mg) | 37 (0–59) | 37 (0–55.8) | 35.8 (2.5–75.5) | 0.433 |
Postoperative nadir hemoglobin (total in g/L) | 93 (85–100) | 94 (87–100) | 92 (83.3–100) | 0.454 |
Intraoperative hypotension | ||||
MAP < 70 mmHg (min) | 342.5 (246–448) | 373 (219–463.8) | 333 (266.3–386) | 0.559 |
MAP < 65 mmHg (min) | 165.5 (73–273) | 171 (58.8–290) | 134 (96.5–209.8) | 0.396 |
MAP < 60 mmHg (min) | 40.5 (12–80) | 53 (9.8–92.8) | 33 (18.5–54.5) | 0.211 |
MAP < 55 mmHg (min) | 7.5 (2–15) | 8 (1.3–15) | 9 (2.3–12.8) | 0.936 |
OR | p-Value | |
---|---|---|
Dobutamine (increase per 1 mg) | 1.02 (1.00 to 1.04) | 0.131 |
Intraoperative fluid balance (increase per 1 L) | 1.61 (0.85 to 3.03) | 0.093 |
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Burkhard, J.-P.; Wepfer, A.; Löffel, L.M.; Bachmann, K.F.; Wuethrich, P.Y. The Role of Intraoperative and Early Postoperative Blood Pressure Variations, Fluid Balance and Inotropics in Fibula Free Flap Head and Neck Reconstruction: A Retrospective Analysis. J. Clin. Med. 2023, 12, 7753. https://doi.org/10.3390/jcm12247753
Burkhard J-P, Wepfer A, Löffel LM, Bachmann KF, Wuethrich PY. The Role of Intraoperative and Early Postoperative Blood Pressure Variations, Fluid Balance and Inotropics in Fibula Free Flap Head and Neck Reconstruction: A Retrospective Analysis. Journal of Clinical Medicine. 2023; 12(24):7753. https://doi.org/10.3390/jcm12247753
Chicago/Turabian StyleBurkhard, John-Patrik, Alena Wepfer, Lukas M. Löffel, Kaspar F. Bachmann, and Patrick Y. Wuethrich. 2023. "The Role of Intraoperative and Early Postoperative Blood Pressure Variations, Fluid Balance and Inotropics in Fibula Free Flap Head and Neck Reconstruction: A Retrospective Analysis" Journal of Clinical Medicine 12, no. 24: 7753. https://doi.org/10.3390/jcm12247753