Author(s)
William Walsh Thomas MD
Jason A. Brant MD
Jason G. Newman MD
Ara A. Chalian MD
Steven B. Cannady MD
Affiliation(s)
Hospital of the University of Pennsylvania
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to discuss the nationwide trends in the surgical management of osteoradionecrosis of the head and neck with a specific focus on free tissue transfer. Objectives: Osteoradionecrosis (ORN) is a debilitating post-treatment sequela with a range of treatment options. There is little data concerning complications and readmissions from a national database. Study Design: Retrospective review of a national database. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2014 was queried for patients being admitted from home for surgery with the ICD-9 corresponding to ORN. Results: The NSQIP database identified 222 patients who underwent surgery for ORN with 75 patients undergoing free tissue transfer. Sixty of these free flaps included bony reconstruction while 15 were soft tissue alone. 83/218 patients had a complication and 53/220 had a serious complication. The presence of a wound infection, decade of life and length of index operation were significantly associated with having a postoperative complication: odds-ratios 3.6, 1.5 and 1.2 respectively. Readmission within 30 days was predicted by underweight BMI, recent weight loss or overweight BMI (ORs: 17.6, 11.6, and 4.5). In an analysis of 3335 patients who underwent free tissue transfer, an ORN diagnosis did not increase the risk of complications on multivariate regression analysis. Conclusions: In this database analysis of ORN patients, there is significant risk for postoperative complications, reoperations and readmissions. However, in regards to free tissue transfer specifically, contrary to anecdotal evidence and case series data, this risk is not shown to be significantly elevated.