Factors Associated With Unplanned Return to Theater in Reconstructive Head and Neck Cancer Patients: A Retrospective Risk Factor Analysis.

Abstract

Unplanned return to theater (URTT) following head and neck cancer reconstruction presents significant clinical and economic challenges. Identifying risk factors for URTT can aid in surgical planning and patient risk stratification. This study evaluates preoperative and intraoperative factors associated with URTT in patients undergoing free flap reconstruction after head and neck tumor resection. A retrospective cohort study was conducted on patients undergoing head and neck tumor resection with free flap reconstruction between July 2015 and January 2024. Demographic, clinical, and operative data were analyzed using univariable and multivariable logistic regression. Of 609 patients included, 199 (32.7%) experienced URTT within 90 days postoperatively. Common indications for URTT included infected collections (33.7%), hematoma (24.6%), and flap dehiscence (16.1%). On univariable analysis, preoperative PEG tube use (unadjusted odds ratio (OR) 1.78 [95% confidence interval (CI) 1.03-3.07], p = 0.04), higher frailty index scores (1.27 [1.03-1.58], p = 0.03), longer operative duration (1.15 [1.06-1.24], p < 0.001), use of bony free flaps (2.08 [1.44-3.01], p < 0.001), and tracheostomy (2.09 [1.22-3.56], p = 0.01) were associated with URTT. Yet, on multivariable analysis, only higher frailty index score (adjusted OR 1.32, 95% CI 1.03-1.70, p = 0.03) and use of bony free flaps (adjusted OR 1.92, 95% CI 1.19-3.11, p < 0.01) retained statistical significance. The findings of this study suggest that frailty and the use of bony free flaps are key risk factors for URTT among reconstructive head and neck cancer patients. These findings support patient risk stratification preoperatively and targeted interventions to reduce the risk of URTT and improve resource utilization in head and neck cancer surgery.