Surgical oncology and reconstructionRisk Factors for Free Flap Failure in 2,846 Patients With Head and Neck Cancer: A National Database Study in Japan
Section snippets
Data Source
We used the Diagnosis Procedure Combination database, a national administrative claims and discharge abstract database in Japan. The details of the database have been described elsewhere.18 In brief, the number of contributing hospitals exceeded 1,000 and the database included the data of approximately 7 million patients recorded in 2012. The Diagnosis Procedure Combination database includes the following information: patient demographic characteristics; main diagnoses, comorbidities at
Results
We identified 2,899 patients with head and neck cancer who underwent tumor resection and consecutive free flap reconstruction during the study period. Of these patients, 53 met one or more of the exclusion criteria; we therefore included 2,846 eligible patients in our final analysis.
There were 94 free flap failures, for an incidence of 3.3%. Of the patients, 42 (1.5%) died during their hospital stay. Five of the patients who died had free flap failure. The median follow-up period was 65 days
Discussion
Using a national database in Japan, we performed a survival analysis for free flap failure of 2,846 patients with head and neck cancer undergoing tumor resection and consecutive free flap reconstruction. Overall, the incidence of free flap failure was 3.3%, and the in-hospital mortality rate was 1.5%. Cox proportional hazards regression indicated that diabetes mellitus, peripheral vascular disease, renal failure, preoperative radiotherapy, and duration of anesthesia greater than 18 hours
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Supported by grants for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (grant Nos. H27-Policy-Designated-009 and H27-Policy-Strategy-011).