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The Impact of Multimorbidity and Anesthesia Type on Complications after Local Flap Reconstruction of Head and Neck Keratinocyte Carcinoma
DeAsia D. Jacob, MD; Brian Gastman, MD
Cleveland Clinic
2019-02-01
Presenter: DeAsia Jacob, MD
Affidavit:
The work on this project has not been published in any journal or previously presented and the resident has completed all of the original work on this project.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
The average yearly cost of keratinocyte carcinoma (KC) is approaching $5 billion and poses a significant impact on healthcare spending. Postoperative complications add to this cost. With the rising incidence of KC and the rising age of the population, plastic surgeons will find themselves treating older patients with multiple medical co-morbidities. As the operative plan is formulated, a patient's medical history may influence the type of anesthesia used. This study aimed to determine if the use of general anesthesia resulted in more complications. A retrospective chart review was performed on patients who underwent local flap reconstruction of biopsy-proven KC from 2013-2018. Univariate and multivariate logistic regression analysis controlling for age, Body Mass Index (BMI), smoking status and number of comorbidities was performed. One hundred seventy-two patients met the inclusion criteria, 98 males (57%) and 74 females (43%). The average age was 65 years. Basal cell carcinoma was the most common diagnosis. The most common comorbid condition was hypertension (51%). Most cases (62%) were under local anesthesia. Complications were evaluated within 3 months after surgery. The overall complication rate was 22%, with 28 minor (16%) and 10 major (6%) complications. Complications were more likely in older patients and those with more comorbidities. Major complications (e.g. pneumonia, hematoma) were more likely in older patients. The use of general anesthesia did not increase the risk of major complications. In properly selected patients, the use of local anesthesia may reduce minor complications. BMI and smoking status were not associated with complications in this study.
