The Role of Immunosuppression on Postoperative Outcomes Following Free Flap Reconstruction

Sunday, September 29, 2024

8:42 AM – 8:48 AM EDT

Location: MBCC, 208

Disclosure(s):

Hanel W. Eberly, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Bao Y. Sciscent, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nguyen Minh Truong, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Neerav Goyal, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Little data exists on the relationship between immunosuppression and postoperative outcomes in patients following head and neck (HN) reconstruction with free flaps.

Methods: In this retrospective cohort study, the TriNetX national database was utilized to compare immunosuppressed and immunocompetent patients who received HN free flap procedures using ICD-10 and CPT codes. Outcomes within 30 days of treatment were analyzed. Sub-analyses were conducted for various etiologies of immunosuppression, including immunosuppressive therapy, HIV status, diabetes, liver disease, and chronic kidney disease (CKD).

Results: After propensity score matching, 3,035 patients were identified. Cohorts for sub-analyses included 286 patients receiving immunosuppressive therapy, 52 patients with HIV, 385 patients with CKD, 500 patients with liver disease, and 1,781 patients with diabetes. Immunosuppressed patients were more likely to experience complications overall (OR 1.21 [1.08-1.36]), wound infection (OR 1.28 [1.1-1.5]), post-operative thromboembolism (OR 1.56 [1.16-2.1]), and death (OR 1.6 [1.05-2.43]). Sub-analyses comparing outcomes by type of immunosuppression found increased rates of overall complications (OR 1.36 [1.17-1.58]), thromboembolism (OR 1.56 [1.07-2.28]), wound infection (OR 1.3 [1.06-1.58]), death (OR 1.95 [1.07-3.59]), and wound dehiscence (OR 1.39 [1.12-1.72]) in patients with diabetes, and increased rates of thromboembolism (OR 1.47 [1.06-2.04]) and wound disruption (OR 1.65 [1.02-2.66]) in patients with CKD. No significant differences in complication rates were found in patients with HIV, liver disease, or those on immunosuppressive therapy compared to immunocompetent patients. Statistical significance was defined as p < 0.05.

Conclusions: Immunosuppressed patients receiving HN reconstruction are at increased risk of postoperative complications compared to immunocompetent patients, especially patients with diabetes and CKD. No significant differences were found in other groups. Surgeons may consider measures to decrease postoperative risk in these patients.

Presenting Author(s)

HE

Hanel W. Eberly, BS

Medical Student
Department of Otolaryngology- Head and Neck Surgery, Penn State Milton S. Hershey Medical Center
Fairfield, CT, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Bao Y. Sciscent, BS

Medical Student
Department of Otolaryngology- Head and Neck Surgery, Penn State Milton S. Hershey Medical Center
Hershey, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Nguyen Minh Truong, BS

Medical Student
Penn State College of Medicine
Hershey, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Jessyka G. Lighthall, MD

Chief, Division of Facial Plastic & Reconstructive Surgery, Associate Professor
Penn State College of Medicine
Hershey, PA, United States

Disclosure information not submitted.

Senior Author(s)

Neerav Goyal, MD, MPH

Associate Professor; Division Chief Head and Neck Surgery; Vice Chair Patient Safety and Quality
Penn State Milton S. Hershey Medical Center
Hershey, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.