Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19

Aaron Domack; Morgan M. Sandelski; Syed Ali; Keith E. Blackwell; Marisa Buchakjian; Andrés M. Bur; Steven B. Cannady; Carlos X. Castellanos; Yadranko Ducic; Tamer A. Ghanem; Andrew T. Huang; Ryan S. Jackson; Niels Kokot; Shawn Li; Patrik Pipkorn; Sidharth V. Puram; Rod Rezaee; Karthik Rajasekaran; Yelizaveta Shnayder; Uttam K. Sinha; Daniel Sukato; Neeraj Suresh; Akina Tamaki; Carissa M. Thomas; Eric J. Thorpe; Mark K. Wax; Sara Yang; Andrea Ziegler; Amy L. Pittman

doi:10.1002/lary.31159

Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19

Aaron Domack, Morgan M. Sandelski, Syed Ali, Keith E. Blackwell, Marisa Buchakjian, Andrés M. Bur, Steven B. Cannady, Carlos X. Castellanos, Yadranko Ducic, Tamer A. Ghanem, Andrew T. Huang, Ryan S. Jackson, Niels Kokot, Shawn Li, Patrik Pipkorn, Sidharth V. Puram, Rod Rezaee, Karthik Rajasekaran, Yelizaveta Shnayder, Uttam K. SinhaDaniel Sukato, Neeraj Suresh, Akina Tamaki, Carissa M. Thomas, Eric J. Thorpe, Mark K. Wax, Sara Yang, Andrea Ziegler, Amy L. Pittman

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) affects the vascular system, subjecting patients to a hypercoagulable state. This is of particular concern for the success of microvascular free flap reconstruction. This study aims to report head and neck free flap complications in patients with COVID-19 during the perioperative period. We believe these patients are more likely to experience flap complications given the hypercoagulable state. Methods: This is a multi-institutional retrospective case series of patients infected with COVID-19 during the perioperative period for head and neck free flap reconstruction from March 2020 to January 2022. Results: Data was collected on 40 patients from 14 institutions. Twenty-one patients (52.5%) had a positive COVID-19 test within 10 days before surgery and 7 days after surgery. The remaining patients had a positive test earlier than 10 days before surgery. A positive test caused a delay in surgery for 16 patients (40.0%) with an average delay of 44.7 days (9–198 days). Two free flap complications (5.0%) occurred with no free flap deaths. Four patients (10.0%) had surgical complications and 10 patients had medical complications (25.0%). Five patients (12.5%) suffered from postoperative COVID-19 pneumonia. Three deaths were COVID-19-related and one from cancer recurrence during the study period. Conclusion: Despite the heightened risk of coagulopathy in COVID-19 patients, head and neck free flap reconstructions in patients with COVID-19 are not at higher risk for free flap complications. However, these patients are at increased risk of medical complications. Level of Evidence: 4 Laryngoscope, 2023.

Original language	English (US)
Journal	Laryngoscope
DOIs	https://doi.org/10.1002/lary.31159
State	Accepted/In press - 2023

Keywords

COVID-19
coagulopathy in microvascular reconstruction
coronavirus
head and neck reconstruction
microvascular free flap
surgical complications in COVID-19

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/lary.31159

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Domack, A., Sandelski, M. M., Ali, S., Blackwell, K. E., Buchakjian, M., Bur, A. M., Cannady, S. B., Castellanos, C. X., Ducic, Y., Ghanem, T. A., Huang, A. T., Jackson, R. S., Kokot, N., Li, S., Pipkorn, P., Puram, S. V., Rezaee, R., Rajasekaran, K., Shnayder, Y., ... Pittman, A. L. (Accepted/In press). Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19. Laryngoscope. https://doi.org/10.1002/lary.31159

Domack, A, Sandelski, MM, Ali, S, Blackwell, KE, Buchakjian, M, Bur, AM, Cannady, SB, Castellanos, CX, Ducic, Y, Ghanem, TA, Huang, AT, Jackson, RS, Kokot, N, Li, S, Pipkorn, P, Puram, SV, Rezaee, R, Rajasekaran, K, Shnayder, Y, Sinha, UK, Sukato, D, Suresh, N, Tamaki, A, Thomas, CM, Thorpe, EJ, Wax, MK, Yang, S, Ziegler, A & Pittman, AL 2023, 'Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19', Laryngoscope. https://doi.org/10.1002/lary.31159

@article{e14877669b964668af752fb2424ee5e3,

title = "Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19",

abstract = "Introduction: Coronavirus disease 2019 (COVID-19) affects the vascular system, subjecting patients to a hypercoagulable state. This is of particular concern for the success of microvascular free flap reconstruction. This study aims to report head and neck free flap complications in patients with COVID-19 during the perioperative period. We believe these patients are more likely to experience flap complications given the hypercoagulable state. Methods: This is a multi-institutional retrospective case series of patients infected with COVID-19 during the perioperative period for head and neck free flap reconstruction from March 2020 to January 2022. Results: Data was collected on 40 patients from 14 institutions. Twenty-one patients (52.5%) had a positive COVID-19 test within 10 days before surgery and 7 days after surgery. The remaining patients had a positive test earlier than 10 days before surgery. A positive test caused a delay in surgery for 16 patients (40.0%) with an average delay of 44.7 days (9–198 days). Two free flap complications (5.0%) occurred with no free flap deaths. Four patients (10.0%) had surgical complications and 10 patients had medical complications (25.0%). Five patients (12.5%) suffered from postoperative COVID-19 pneumonia. Three deaths were COVID-19-related and one from cancer recurrence during the study period. Conclusion: Despite the heightened risk of coagulopathy in COVID-19 patients, head and neck free flap reconstructions in patients with COVID-19 are not at higher risk for free flap complications. However, these patients are at increased risk of medical complications. Level of Evidence: 4 Laryngoscope, 2023.",

keywords = "COVID-19, coagulopathy in microvascular reconstruction, coronavirus, head and neck reconstruction, microvascular free flap, surgical complications in COVID-19",

author = "Aaron Domack and Sandelski, {Morgan M.} and Syed Ali and Blackwell, {Keith E.} and Marisa Buchakjian and Bur, {Andr{\'e}s M.} and Cannady, {Steven B.} and Castellanos, {Carlos X.} and Yadranko Ducic and Ghanem, {Tamer A.} and Huang, {Andrew T.} and Jackson, {Ryan S.} and Niels Kokot and Shawn Li and Patrik Pipkorn and Puram, {Sidharth V.} and Rod Rezaee and Karthik Rajasekaran and Yelizaveta Shnayder and Sinha, {Uttam K.} and Daniel Sukato and Neeraj Suresh and Akina Tamaki and Thomas, {Carissa M.} and Thorpe, {Eric J.} and Wax, {Mark K.} and Sara Yang and Andrea Ziegler and Pittman, {Amy L.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2023",

doi = "10.1002/lary.31159",

language = "English (US)",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19

AU - Domack, Aaron

AU - Sandelski, Morgan M.

AU - Ali, Syed

AU - Blackwell, Keith E.

AU - Buchakjian, Marisa

AU - Bur, Andrés M.

AU - Cannady, Steven B.

AU - Castellanos, Carlos X.

AU - Ducic, Yadranko

AU - Ghanem, Tamer A.

AU - Huang, Andrew T.

AU - Jackson, Ryan S.

AU - Kokot, Niels

AU - Li, Shawn

AU - Pipkorn, Patrik

AU - Puram, Sidharth V.

AU - Rezaee, Rod

AU - Rajasekaran, Karthik

AU - Shnayder, Yelizaveta

AU - Sinha, Uttam K.

AU - Sukato, Daniel

AU - Suresh, Neeraj

AU - Tamaki, Akina

AU - Thomas, Carissa M.

AU - Thorpe, Eric J.

AU - Wax, Mark K.

AU - Yang, Sara

AU - Ziegler, Andrea

AU - Pittman, Amy L.

PY - 2023

Y1 - 2023

N2 - Introduction: Coronavirus disease 2019 (COVID-19) affects the vascular system, subjecting patients to a hypercoagulable state. This is of particular concern for the success of microvascular free flap reconstruction. This study aims to report head and neck free flap complications in patients with COVID-19 during the perioperative period. We believe these patients are more likely to experience flap complications given the hypercoagulable state. Methods: This is a multi-institutional retrospective case series of patients infected with COVID-19 during the perioperative period for head and neck free flap reconstruction from March 2020 to January 2022. Results: Data was collected on 40 patients from 14 institutions. Twenty-one patients (52.5%) had a positive COVID-19 test within 10 days before surgery and 7 days after surgery. The remaining patients had a positive test earlier than 10 days before surgery. A positive test caused a delay in surgery for 16 patients (40.0%) with an average delay of 44.7 days (9–198 days). Two free flap complications (5.0%) occurred with no free flap deaths. Four patients (10.0%) had surgical complications and 10 patients had medical complications (25.0%). Five patients (12.5%) suffered from postoperative COVID-19 pneumonia. Three deaths were COVID-19-related and one from cancer recurrence during the study period. Conclusion: Despite the heightened risk of coagulopathy in COVID-19 patients, head and neck free flap reconstructions in patients with COVID-19 are not at higher risk for free flap complications. However, these patients are at increased risk of medical complications. Level of Evidence: 4 Laryngoscope, 2023.

AB - Introduction: Coronavirus disease 2019 (COVID-19) affects the vascular system, subjecting patients to a hypercoagulable state. This is of particular concern for the success of microvascular free flap reconstruction. This study aims to report head and neck free flap complications in patients with COVID-19 during the perioperative period. We believe these patients are more likely to experience flap complications given the hypercoagulable state. Methods: This is a multi-institutional retrospective case series of patients infected with COVID-19 during the perioperative period for head and neck free flap reconstruction from March 2020 to January 2022. Results: Data was collected on 40 patients from 14 institutions. Twenty-one patients (52.5%) had a positive COVID-19 test within 10 days before surgery and 7 days after surgery. The remaining patients had a positive test earlier than 10 days before surgery. A positive test caused a delay in surgery for 16 patients (40.0%) with an average delay of 44.7 days (9–198 days). Two free flap complications (5.0%) occurred with no free flap deaths. Four patients (10.0%) had surgical complications and 10 patients had medical complications (25.0%). Five patients (12.5%) suffered from postoperative COVID-19 pneumonia. Three deaths were COVID-19-related and one from cancer recurrence during the study period. Conclusion: Despite the heightened risk of coagulopathy in COVID-19 patients, head and neck free flap reconstructions in patients with COVID-19 are not at higher risk for free flap complications. However, these patients are at increased risk of medical complications. Level of Evidence: 4 Laryngoscope, 2023.

KW - COVID-19

KW - coagulopathy in microvascular reconstruction

KW - coronavirus

KW - head and neck reconstruction

KW - microvascular free flap

KW - surgical complications in COVID-19

UR - http://www.scopus.com/inward/record.url?scp=85176257449&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85176257449&partnerID=8YFLogxK

U2 - 10.1002/lary.31159

DO - 10.1002/lary.31159

M3 - Article

AN - SCOPUS:85176257449

SN - 0023-852X

JO - Laryngoscope

JF - Laryngoscope

ER -

Free Flap Outcomes for Head and Neck Surgery in Patients with COVID-19

Abstract

Keywords

ASJC Scopus subject areas

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