(414) Impact of Comorbidities on Perioperative Outcomes in Head and Neck Free Flap Reconstruction Surgery

Introduction: Free flap reconstruction remains safe across age groups, yet prior studies suggest that comorbidity burden may be more predictive of postoperative outcomes than chronologic age, with inconsistent associations reported for specific complications due to heterogeneous comorbidity measures and an emphasis on broad endpoints. This study evaluates how global comorbidity burden influences perioperative outcomes in a large cohort of head and neck free flap reconstructions.

Methods: 361 free flap surgeries performed between January 2020 and January 2024 at a single tertiary-referral center were reviewed. Data were collected on comorbidities, infections, flap dehiscence, return to OR, and other perioperative outcomes. Comorbidity burden was measured using the Charlson Comorbidity Index (CCI).

Results: Each one-unit increase in CCI was associated with higher odds of ICU upgrade (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.24–1.66; p < 0.001), postoperative transfusion (OR 1.25, 95% CI 1.14–1.38; p < 0.001), wound dehiscence (OR 1.16, 95% CI 1.06–1.27; p = 0.002), and 30-day return to the operating room (OR 1.17, 95% CI 1.04–1.32; p = 0.008). CCI was not significantly associated with postoperative wound infection (OR 1.06, 95% CI 0.95–1.18; p = 0.28) or 30-day readmission (OR 1.06, 95% CI 0.92-1.22; p = 0.27).

Conclusions: Many complications associated with elevated CCI, including wound dehiscence, transfusion requirement, ICU escalation, and unplanned reoperation, may not result in flap loss but nonetheless contribute to increased morbidity and healthcare utilization. These findings support incorporating comorbidities into preoperative risk stratification and perioperative planning, with future work needed to evaluate targeted optimization strategies for high-CCI patients.