Perioperative cardiac complications in patients undergoing head and neck free flap reconstruction.

Background: Limited data exists on cardiac complications following head and neck free flaps.

Design: A retrospective review was performed on patients that underwent free flap reconstruction from 2012 to 2015.

Results: 368 flaps were performed. 12.5% of patients experienced a cardiac event. Hypertension, coronary artery disease, heart failure, venous thromboembolism, and anticoagulation were associated with cardiac complications. ASA class was not predictive of cardiac events. 7.6% of patients required anticoagulation, which exhibited a strong association with surgical site hematoma. Cardiac complications led to a significantly increased length of stay.

Conclusions: There is a significant rate of cardiac events in this cohort. When estimating risk, a patient's total burden of comorbidities is more important than any one factor. ASA Class fails to demonstrate utility in this setting. Cardiac events have implications for quality-related metrics including length of stay and hematoma rate.