The Influence of Vasopressors on Free Flap Outcomes in Head and Neck Cancer Patients

Objective: To compare free flap outcomes between those who received and did not receive vasopressors (VPs) at the time of free flap reconstruction. Study Design: This retrospective cohort study includes patients from January 2013 to January 2023. Setting: This multicenter cohort study utilized data from the TriNetX Research Network which includes 80 health care organizations. Methods: Head and neck cancer patients older than 18 years who underwent free flap reconstruction were separated into those who received or did not receive VPs on the day of surgery. The primary outcomes were flap failure defined by need for secondary free flap procedures, blood vessel repair, and other flap revision procedures. Results: After propensity score matching, 7446 patients were analyzed. The VP group included 3723 patients (mean age [SD], 62.9 [11.4] years; 2511 males [67.4%]). The non-VP group included 3723 patients (mean age [SD], 63.0 [11.2] years; 2479 males [66.6%]). Free flap outcomes were not statistically different between groups (secondary free flap: 166 [4.5%] VP vs 155 [4.2%] non-VP, P =.04; vessel repair: 314 [8.4%] vs 319 [8.6%], P =.06; other flap revision procedures: 416 [11.2%] vs 449 [12.1%], P =.02). Bony flaps were found to have decreased rates of vessel repair in the VP group (47 [6.1%] vs 69 [9.0%], P =.003]. For secondary outcomes, pneumonia (173 [4.6%] vs 231 [6.2%], P =.0002), urinary tract infection (34 [1.0%] vs 59 [1.6%], P =.0007), and deep vein thrombosis (93 [2.5%] vs 122 [3.3%], P =.004) were significantly different. Conclusion: VP use is not significantly associated with free flap complications. These results imply that VP use on the same day as surgery may be safe if clinically necessary.