Is the use of intraoperative vasopressors associated with flap failure in head and neck free tissue transfer surgery?

[BACKGROUND] Maintaining appropriate blood pressure during head and neck free tissue transfer surgery is important for both organ and flap perfusion. However, the use of vasopressors to treat intraoperative hypotension is controversial. The purpose of this prospective cohort study is to evaluate the impact of intraoperative vasopressors on the incidence of flap necrosis.

[METHODS] This prospective cohort study examined patients undergoing free tissue transfer surgery of the head and neck between January 2020 and December 2021 at Peking University School and Hospital of Stomatology. Exclusion criteria included history of preoperative radiotherapy or smoking and American Society of Anesthesiologists (ASA) physical status classification IV or V. The predictor variable was intraoperative vasopressor use and patients were grouped accordingly. The outcome variable was early total flap necrosis(flap failure within 7 days of the operation or before discharge). Univariate logistic regression was used to determine potential risk factors for early flap necrosis. Multivariate regression analyses with sequential adjustment for potential confounding factors was then performed to determine whether these factors were independently associated with flap necrosis. Meanwhile, linear regression analyses were performed with patients stratified according to age and sex to explore the relationship between risk factors and flap outcome.

[RESULTS] A total of 239 participants were enrolled, with 121 in the vasopressor group and 118 in the no vasopressor group. Age, ASA classification, Charlson comorbidity index, and flap ischemia duration significantly differed between the groups. Although vasopressor use (odds ratio [OR], 1.65; 95 % confidence interval [CI], 0.39-7.07; P = 0.499) was not significantly associated with flap necrosis in univariate analysis, operation duration (OR, 1.01; 95 % CI, 1.01-1.01; P = 0.001] and flap ischemia duration (OR,1.02; 95 % CI, 1.01-1.03; P = 0.006) were. The smooth curve fitting results demonstrated that both operation duration and flap ischemia duration had a positive linear correlation with flap necrosis.

[CONCLUSIONS] Use of intraoperative vasopressors during free flap transfer surgery of the head and neck was not associated with early flap failure.

[TRIAL REGISTRATION] The study was registered with the Chinese Clinical Trial Registry (ChiCTR2100043119).