Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction

The British Association of Oral and Maxillofacial Surgeons (BAOMS) Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) reconstructive audit aims to provide surgical teams with risk adjusted comparative performance data. The goal is to enable surgeons to optimise surgical pathways. Risk adjustment requires that data on appropriate predictive variables are collected. This study looked at variables predicting major complications and fl ap failure in a single institution with the aim of determining whether the QOMS dataset adequately captures the appropriate data points. A prospective database of head and neck fl ap procedures and associated postoperative complications has been maintained in the maxillofacial surgery department since August 2009 up to August 2022 (n=1327). A total of 25 putative risk variables were extracted from the health records for each patient. The outcomes of interest were total fl ap failure and major complications. Independent predictors of fl ap failure were recipient site (sinonasal/anterior skull base), previous major surgery, previous major surgery and radiotherapy, and fl ap selection. For major complications ACE-27 comorbidity score, fl ap type, use of tracheostomy, elevated preoperative plasma C-reactive protein (CRP) and fl ap selection were independently predictive. Apart from preoperative activated innate immunity all relevant risk stratification variables identified in this study form part of the QOMS dataset. QOMS is therefore likely to adequately risk stratify patients based upon currently collected variables. (c) 2024 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.