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APACHE II Scoring for the Prediction of Immediate Surgical Complications in Head and Neck Cancer Patients

Grant, Chris A. M.B., B.S.; Dempsey, Ged A. M.B., Ch.B.; Lowe, Derek M.Sc.; Brown, James S. M.B., Ch.B.; Vaughan, E David M.B., B.Ch.; Rogers, Simon N. M.B., Ch.B.

Plastic and Reconstructive Surgery: May 2007 - Volume 119 - Issue 6 - p 1751-1758
doi: 10.1097/01.prs.0000259038.36210.f8
Reconstructive: Head and Neck: Original Articles

Background: Aggressive surgical treatment of oral and oropharyngeal cancers may be compromised by significant surgical complications. Early identification of patients at risk for postoperative complications may assist in clinical decision-making. The objective of this study was to assess the value of the Acute Physiology and Chronic Health Evaluation (APACHE II) score in predicting early postoperative surgical complications.

Methods: There were 510 cases of free tissue transfer surgery identified on the Liverpool Oncology Head and Neck Database for 1995 to 2002. APACHE II data were collected independently from critical care records and by case note retrieval. The authors' main a priori outcomes were total flap failure and any immediate complication requiring further surgery (including any from hemorrhage, hematoma, partial flap failure, airways, and anastomosis exploration).

Results: Overall total flap loss and immediate complication rates were 6.2 percent (30 of 485) and 13.6 percent (66 of 485), respectively. APACHE II data were known for 399 operations (82 percent) and, of these, 90 percent (360 of 399) were managed postoperatively in the critical care unit. There were clear correlations between APACHE II scores with total flap loss and with other immediate complications.

Conclusions: The APACHE II score is associated with immediate postoperative surgical complications involving flap compromise and thus may be a useful tool in postoperative decision-making.

Liverpool, United Kingdom

From the Critical Care Department and the Department of Maxillofacial Surgery, University Hospital Aintree.

Received for publication July 14, 2005; accepted October 13, 2005.

Presented at the Sixth International Conference on Head and Neck Cancer, in Washington, D.C., August of 2004.

Chris A. Grant, M.B., B.S., Intensive Care Unit, Alfred Hospital, Melbourne 3004, Australia,

©2007American Society of Plastic Surgeons