Liver Disease Predicts 30-Day Postoperative Complications in Head and Neck Microvascular Surgery.

[OBJECTIVE] To investigate the association between liver disease and postoperative outcomes of head and neck microvascular free tissue transfer (MFTT) surgeries.

[METHODS] This retrospective cohort study queried the 2005 to 2021 American College of Surgeons National Surgical Quality Improvement Program databases. Reconstructive cases performed by otolaryngologists (CPT: 15756, 15757, 15758, 15842, 20955, 20956, 20957, 20962, 20969, 20970, 20972, 20973, 43116, 43496, 49006, and 49906) with available age values and preoperative laboratory data were included. Liver disease severity was assessed using the AST-to-platelet ratio index (APRI), a marker of liver fibrosis, and the Model for End-Stage Liver Disease-Sodium (MELD-Na), which predicts mortality. Mild liver disease (MLD) was classified as an APRI score ≥ 0.7 and a MELD-Na score < 10. Advanced liver disease (ALD) was defined as an APRI score ≥ 0.7 and a MELD-Na score ≥ 10. Univariate and multivariable logistic regression were performed.

[RESULTS] A total of 5459 cases met the inclusion criteria, of which 93 (1.7%) had mild liver disease, and 105 (1.9%) had advanced liver disease. Adjusted multivariable logistic regression showed that ALD was associated with a significantly higher risk of postoperative complications (OR = 1.62, p = 0.03), medical complications (OR = 2.05, p < 0.01), and return to the operating room within 30 days (OR = 1.87, p = 0.01). ALD patients also experienced prolonged hospital stays and a higher incidence of pneumonia, unplanned intubation, and acute renal failure.

[CONCLUSION] ALD is correlated with increased postoperative complication risks in MFTT surgeries. This study suggests that preoperative liver function assessment and optimization may mitigate surgical risks.