| Summary: | 碩士 === 輔英科技大學 === 護理系碩士班 === 107 === Background:As the age of head and neck cancer declines and the incidence increases gradually, more and more patients undergo free flap reconstruction. Time consuming free flap reconstruction often causes unanticipated complications, such as surgical flap skin necrosis, systemic complications such as pneumonia, which prolongs the length of hospital stay and increases the cost of medical care. For patients, the treatment process of suffering is more psychologically impactful.
Objective:The purpose of this study is to analysis the head and neck cancer patient’s characteristics and related factors of post-operative complications after free flap reconstruction in a medical center.
Method:This retrospective study was conducted to collect 442 patients who were admitted to the surgical intensive care unit after the reconstruction surgery in 2015-2018, and analyzed the associated factors related to the complications with the patient and medical care.
Result:The results of this study found that in the surgical site complications, postoperative flap blood supply disorder were associated with smoking, return to the operating room, abnormal notification time, length of ventilator used, length of intensive care unit stay, length of hospital stay with statistically significant difference. Surgical site infection was associated with cancer stage, liver disease, flap type, flap size, re-entry to the operating room, preoperative and postoperative albumin level, preoperative hemoglobin, intraoperative blood loss, length of hospital stay, postoperative first day blood pressure less than 100mmHg with statistically significant; Occurrence of wound complications were significant associated with re-entry to the operating room, flap type, postoperative albumin level, preoperative and postoperative hemoglobin levels, intraoperative blood loss, postoperative hospital stay. There were statistically significant differences of the incidence of partial or total flap failure complications in re-entry into the operating room, the type of flap, and the number of postoperative hospital stays; in systemic complications, pneumonia and heart disease, preoperative albumin level, length of ventilator used, the length of the intensive care unit stay, and the number of postoperative hospital stays were found to have statistically significant differences. There were statistically significant differences of delirium in gender, age, length of ventilator used, length of intensive care unit stay, and systolic blood pressure greater than 150 mmHg on the second postoperative day. Further multivariate logistic regression analysis was performed on the surgical site complications occurred in patients with head and neck cancer free flap reconstruction. Related factors included returning to the operating room, length of intensive care unit stay, postoperative hospital stay, postoperative first day systolic blood pressure less than 100mmHg, and the type of flap. The reasons of the return to the operating room included flap blood supply disorder, infection, wound complications, partial or total flap failure; pneumonia and delirium in patients with head and neck cancer after free flap reconstruction was the length of ventilator used.
Conclusions:We expected that the result of this study can be used clinically to provide clinical practitioners with an understanding of the associated factors of complications during medical care after free flap reconstruction. Preoperative detailed assessment, reduce postoperative complications, and early screening for possible complications. Patients who are in the high risk group, especially those who return to the operating room, closely monitor their vital signs, implement flap monitoring, prevent infection, reduce the frequency of reentry into the operating room. The length of ventilator used is a predictor of the systemic complications; therefore, early weaning of ventilator is a goal to reduce pneumonia and delirium.
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