Intraoperative Use of Vasopressors Is Safe in Head and Neck Free Tissue Transfer

Edward W. Swanson; Hsu-Tang Cheng; Srinivas M. Susarla; Georgia C. Yalanis; Denver M. Lough; Owen Johnson III; Anthony P. Tufaro; Paul N. Manson; Justin M. Sacks

doi:10.1055/s-0035-1563381

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2016; 32(02): 087-093
DOI: 10.1055/s-0035-1563381

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intraoperative Use of Vasopressors Is Safe in Head and Neck Free Tissue Transfer

Edward W. Swanson

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Hsu-Tang Cheng

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

²Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, China Medical University School of Medicine, Taichung City, Taiwan

,

Srinivas M. Susarla

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Georgia C. Yalanis

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Denver M. Lough

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Owen Johnson III

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Anthony P. Tufaro

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Paul N. Manson

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Justin M. Sacks

¹Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland

› Author Affiliations

Abstract

Background The purpose of this study is to identify whether intraoperative use of vasoactive medications increases the risk of free flap failure or complications through a systematic review and meta-analysis.

Materials and Methods PubMed/MEDLINE, EMBASE, and Scopus databases were searched for studies published through January 2015. English publications that met the following criteria were included: (1) adult patients undergoing head and neck free flap reconstruction; (2) comparison of patients with and without intraoperative vasopressor administration; and (3) documentation of flap failure rate and/or flap complications. The primary outcome was the incidence of flap failure. The secondary outcome was the incidence of overall flap complications. Meta-analysis was performed to obtain pooled odds ratios (ORs) of the effect of intraoperative use of vasopressors on flap failure and complication rates.

Results Four cohort studies met inclusion criteria. All studies were of high methodological quality with an average Methodological Index for Non-Randomized Studies score of 18.75 (range 16–23). A total of 933 patients undergoing head and neck free flap reconstruction were included. Meta-analysis demonstrated no statistically significant difference in the incidence of flap failure (2.9 vs. 3.6%; OR, 0.68; 95% confidence interval [CI], 0.23–1.99; p = 0.48) or incidence of flap complications (16.8 vs. 18.6%; OR, 0.92; 95% CI, 0.60–1.42; p = 0.71).

Conclusion Based on the current evidence, intraoperative use of vasopressors has no impact on the incidence of flap failure or flap complications.

Keywords

vasopressor - microvascular surgery - microsurgery - head and neck - free tissue transfer - free flap - meta-analysis - systematic review - complications

Full Text

References

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