Factors Influencing the Incidence of Severe Complications in Head and Neck Free Flap Reconstructions.

BACKGROUND: Complications after head and neck free-flap reconstructions are detrimental and prolong hospital stay. In an effort to identify related variables in a tertiary regional head and neck unit, the microvascular reconstruction activity over the last 5 years was captured in a database along with patient-, provider-, and volume-outcome-related parameters. METHODS: Retrospective cohort study (level of evidence 3), a modified Clavien-Dindo classification, was used to assess severe complications. RESULTS: A database of 217 patients was created with consecutively reconstructed patients from 2009 to 2014. In the univariate analysis of severe complications, we found significant associations (P < 0.05) between type of flap used, American Society of Anesthesiologists classification, T-stage, microscope use, surgeon, flap frequency, and surgeon volume. Within a binomial logistic regression model, less frequently versus frequently performed flap (odds ratio [OR] = 3.2; confidence interval [CI] = 2.9-3.5; P = 0.000), high-volume versus low-volume surgeon (OR = 0.52; CI = -0.22 to 0.82; P = 0.007), and ASA classification (OR = 2.9; CI = 2.4-3.4; P = 0.033) were retained as independent predictors of severe complications. In a Cox-regression model, surgeon (P = 0.011), site of reconstruction (P = 0.000), T-stage (P = 0.001), and presence of severe complications (P = 0.015) correlated with a prolonged hospitalization. CONCLUSIONS: In this study, we identified a correlation of patient-related factors with severe complications (ASA score) and prolonged hospital stay (T-stage, site). More importantly, we identified several provider- (surgeon) and volume-related (frequency with which a flap was performed and high-volume surgeon) factors as predictors of severe complications. Our data indicate that provider- and volume-related parameters play an important role in the outcome of microvascular free-flap procedures in the head and neck region.

[Acute otitis media and short-term complications]. / Otite moyenne aiguë et complications à court terme.

Oral antibiotic have changed the incidence of otitic intracranial complications. In spite of therapeutic progress, these complications remain serious, potentially life-threatening and may result in long-life consequences. Acute otitis media diagnosis and knowledge of intracranial complications' symptoms are required for early and adapted therapeutics. Care strategies evolve with the continuously improvement of medical technologies, development of new vaccines and targeted use of antibiotics.