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Delayed Mobilization After Microsurgical Reconstruction For Oral Cancer Resection: An Independent Risk Factor For Pneumonia
Justin K. Yeung, MD, Robertson Harrop, MD MSc, Naushad Hirani, MD, Joseph Dort, MD MSc, Christiaan Schrag, MD.
University of Calgary, Calgary, AB, Canada.

Abstract
Purpose:
Large defects secondary to oral cancer resection are commonly reconstructed with microsurgical free flaps. Pulmonary complications in these patients are common and increase mortality, morbidity and hospital costs. Post-operative mobilization and chest physiotherapy are recommended to decrease respiratory complications in surgical patients however many microsurgeons are reluctant to adopt early mobilization protocols due to the perceived risk of flap compromise. The purpose of this study was to determine the incidence of pneumonia and other pulmonary complications among patients undergoing oral cancer resection followed by immediate free flap reconstruction in a Canadian tertiary cancer referral centre and in particular to compare the incidence of these complications between patients mobilized early (less than 4 days post-op) versus those mobilized later. A secondary goal was to determine whether early postoperative mobilization affected microvascular flap outcome.
Methods:
Sixty-two consecutive patients treated between 2005-2009 with oral carcinoma resection and free flap reconstruction were studied.
Information was collected pertaining to presurgical comorbidities, operative treatment, postoperative care, pulmonary complications and flap complications. Risk factors for development of pulmonary and flap complications were studied by univariate and multivariate analysis.
Results:
The overall incidence of pneumonia was 30.6%. Longer ICU stay (p=0.01), tracheostomy decannulation later than 10 days (p=0.04) and longer operative times (p=0.04) were significantly associated with pneumonia. Delayed mobilization (after day 4 postop) was an independent risk factor for pneumonia (OR=4.2, 95% CI: 1.1, 17.1). On the other hand early moblilization (before day 4 postop) was not associated with an increased incidence of secondary flap procedures or flap failure.
Conclusions:
Our findings suggest that late mobilization of free flap patients is an independent risk factor for developing post-operative pneumonia. Early mobilization does not increase flap failure rates and is safe. It should be strongly considered in all free flap patients as a means to reduce pulmonary complications.
Level of Evidence: II Prognostic/Risk Study


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