The effect of anesthesia management on perioperative outcomes in free flap surgery

Objective: The aim of our study is to retrospectively analyze the perioperative complications of free flap surgery cases under anesthesia in plastic and reconstructive surgery, the correlation of the processes associated with the development of these complications, and contribute to the literature. Material and Method: This study included 52 patients who underwent free flap surgery performed by the Department of Plastic, Reconstructive and Aesthetic Surgery at Cukurova University Faculty of Medicine Hospital between January 2021 and November 2024. Patients' demographic characteristics, preoperative and postoperative laboratory data, intraoperative anesthesia and surgery-related features, postoperative complications, length of hospital stay, length of intensive care unit stay, reoperation status, and postoperative exitus were recorded by scanning the hospital information management system and archive files. Results: The data of 54 patients who underwent free flap surgery by the Department of Plastic, Reconstructive and Aesthetic Surgery of our hospital during the study period were examined and evaluated. Two of the 54 patients were excluded from the study due to insufficient data, and 52 patients were included in the study. 18 of the patients were female (34.6%), 34 were male (65.4%), and the mean age was 43.1±20.9 years. 19 patients (36.5%) were ASA I, 28 patients (53.9%) were ASA II, 4 patients (7.7%) were ASA III, and 1 patient (1.9%) was ASA IV. The number of patients with concomitant systemic disease was 33 (63.5%); 17 of them had smoking addiction (32.7%), 9 had diabetes mellitus (17.3%), and 7 had hypertension. The most common intraoperative complication was hypotension (9.6%). The most common postoperative complications were surgical site infection (28.8%) and flap necrosis (15.4%). The reoperation rate was 28.8%. The 30-day postoperative mortality rate was 3.8%. In patients who developed postoperative complications; the preoperative median platelet count was statistically significantly lower, the median amount of crystalloid fluid administered during the intraoperative period was statistically significantly higher, and the mean operation time was statistically significantly longer (p<0.05). The effect of other examined parameters on the development of postoperative complications could not be demonstrated (p>0.05). It was found that the reoperation rate was statistically significantly higher and the length of hospital stay was statistically significantly longer in patients with complications (p<0.05). Conclusion: It was concluded that factors such as age, ASA score, gender, concomitant systemic disease, preoperative hemoglobin, and choice of anesthetic agent were not effective on postoperative complications; factors such as low preoperative platelet count and excessive fluid resuscitation during the intraoperative period increased postoperative complications. Keywords: Flap physiology, postoperative complication, free flap surgery, fluid management, platelet count