Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot study
Abstract Background Free flap reconstruction for head and neck cancer is associated with a high risk of perioperative complications. One of the modifiable risk factors associated with perioperative morbidity is intraoperative hypotension (IOH). The main aim of this pilot study is to determine if the...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Health Science Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/hsr2.1943 |
| _version_ | 1827304072688959488 |
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| author | Justine Philteos Stuart A. McCluskey Sophia Emerson George Djaiani David Goldstein Sabri Soussi |
| author_facet | Justine Philteos Stuart A. McCluskey Sophia Emerson George Djaiani David Goldstein Sabri Soussi |
| author_sort | Justine Philteos |
| collection | DOAJ |
| description | Abstract Background Free flap reconstruction for head and neck cancer is associated with a high risk of perioperative complications. One of the modifiable risk factors associated with perioperative morbidity is intraoperative hypotension (IOH). The main aim of this pilot study is to determine if the intraoperative use of goal‐directed hemodynamic therapy (GDHT) is associated with a reduction in the number of IOH events in this population. Methods A before‐and‐after study design. The patients who had intraoperative GDHT were compared to patients from a previous period before the implementation of GDHT. The primary outcome was the number of IOH episodes defined as five or more successive minutes with a mean arterial pressure <65 mmHg. The secondary outcomes included major postoperative morbidity and 30‐day mortality. Results A total of 414 patients were included. These were divided into two groups. The control group (n = 346; January 1, 2018, to December 31, 2019), and the monitored group (n = 68; January 1, 2020, to May 1, 2021). The median intraoperative administered fluid volume was similar between the control and monitored groups (2250 interquartile range [IQR] [1607–3050] vs. 2210 IQR [1700–2807] mL). The monitored group was found to have an increased use of norepinephrine and dobutamine (respectively, 1.2% vs. 5.9% and 2.4% vs. 30.9%; p < 0.05). When adjusting for confounders (comorbidities, estimated blood loss, and duration of anesthesia) the incidence rate ratio (95% confidence interval) of number of IOH events was 0.94 (0.86–1.03), p = 0.24. The rate of postoperative flap and medical complications did not differ between the two groups. Conclusions Even though the use of vasopressors/inotropes was higher in the monitored group, the number of IOH episodes and postoperative morbidity and mortality were similar between the two groups. Further change in hemodynamic management will require the use of specific blood pressure targets in the GDHT fluid algorithm. |
| first_indexed | 2024-04-24T17:12:39Z |
| format | Article |
| id | doaj.art-514e38e088b9422db07306e38d7c25d3 |
| institution | Directory Open Access Journal |
| issn | 2398-8835 |
| language | English |
| last_indexed | 2024-04-24T17:12:39Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Health Science Reports |
| spelling | doaj.art-514e38e088b9422db07306e38d7c25d32024-03-28T08:36:41ZengWileyHealth Science Reports2398-88352024-03-0173n/an/a10.1002/hsr2.1943Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot studyJustine Philteos0Stuart A. McCluskey1Sophia Emerson2George Djaiani3David Goldstein4Sabri Soussi5Department of Otolaryngology—Head and Neck Surgery University Health Network, University of Toronto Toronto Ontario CanadaDepartment of Anesthesiology and Pain Medicine University of Toronto Toronto Ontario CanadaDepartment of Anesthesiology and Pain Medicine University of Toronto Toronto Ontario CanadaDepartment of Anesthesiology and Pain Medicine University of Toronto Toronto Ontario CanadaDepartment of Otolaryngology—Head and Neck Surgery University Health Network, University of Toronto Toronto Ontario CanadaDepartment of Anesthesiology and Pain Medicine University of Toronto Toronto Ontario CanadaAbstract Background Free flap reconstruction for head and neck cancer is associated with a high risk of perioperative complications. One of the modifiable risk factors associated with perioperative morbidity is intraoperative hypotension (IOH). The main aim of this pilot study is to determine if the intraoperative use of goal‐directed hemodynamic therapy (GDHT) is associated with a reduction in the number of IOH events in this population. Methods A before‐and‐after study design. The patients who had intraoperative GDHT were compared to patients from a previous period before the implementation of GDHT. The primary outcome was the number of IOH episodes defined as five or more successive minutes with a mean arterial pressure <65 mmHg. The secondary outcomes included major postoperative morbidity and 30‐day mortality. Results A total of 414 patients were included. These were divided into two groups. The control group (n = 346; January 1, 2018, to December 31, 2019), and the monitored group (n = 68; January 1, 2020, to May 1, 2021). The median intraoperative administered fluid volume was similar between the control and monitored groups (2250 interquartile range [IQR] [1607–3050] vs. 2210 IQR [1700–2807] mL). The monitored group was found to have an increased use of norepinephrine and dobutamine (respectively, 1.2% vs. 5.9% and 2.4% vs. 30.9%; p < 0.05). When adjusting for confounders (comorbidities, estimated blood loss, and duration of anesthesia) the incidence rate ratio (95% confidence interval) of number of IOH events was 0.94 (0.86–1.03), p = 0.24. The rate of postoperative flap and medical complications did not differ between the two groups. Conclusions Even though the use of vasopressors/inotropes was higher in the monitored group, the number of IOH episodes and postoperative morbidity and mortality were similar between the two groups. Further change in hemodynamic management will require the use of specific blood pressure targets in the GDHT fluid algorithm.https://doi.org/10.1002/hsr2.1943cardiac outputhead and neck free flap surgeryhemodynamic monitoringintraoperative hypotensionpostoperative outcomes |
| spellingShingle | Justine Philteos Stuart A. McCluskey Sophia Emerson George Djaiani David Goldstein Sabri Soussi Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot study Health Science Reports cardiac output head and neck free flap surgery hemodynamic monitoring intraoperative hypotension postoperative outcomes |
| title | Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot study |
| title_full | Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot study |
| title_fullStr | Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot study |
| title_full_unstemmed | Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot study |
| title_short | Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot study |
| title_sort | impact of goal directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery a before and after pilot study |
| topic | cardiac output head and neck free flap surgery hemodynamic monitoring intraoperative hypotension postoperative outcomes |
| url | https://doi.org/10.1002/hsr2.1943 |
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