Postoperative morbidity and mortality in patients with end-stage renal disease undergoing free flap reconstruction of the head and neck

Background: Relatively little data exists regarding the ways in which end-stage renal disease (ESRD) affects microvascular surgery outcomes. This study sought to identify whether ESRD was an independent predictor of 30-day postoperative complication and readmission rates after head & neck free flap reconstruction. Methods: The TriNetX database was used to identify individuals who underwent head and neck free flap reconstruction between 2014 and 2023. Two cohorts were created based on whether or not patients had ESRD. Propensity score matching based on demographics and relevant comorbidities was performed. Differences in 30-day complication and readmission rates were then compared between cohorts. Results: After propensity matching was performed, ESRD patients were noted to have significantly higher risks of deep vein thrombosis (7.8% vs 3.4%; aRR: 2.308, p = 0.008), myocardial infarction (6.5% vs 2.9%; aRR: 2.005, p = 0.045), pneumonia (19.2% vs 10.1%; aRR: 1.897, p < 0.001), anemia (23.3% vs 16.1%; aRR: 1.452, p = 0.011), skin graft-associated complications (7.5% vs 2.6%; aRR: 2.900, p = 0.002), fluid overload (7.8% vs 4.1%; aRR: 1.862, p = 0.043) and mortality (5.7% vs 2.6%; aRR: 2.200, p = 0.030). Compared to controls, ESRD patients had a lower likelihood of readmission (8.8% vs 14.0%, aRR: 0.630, p = 0.024). Conclusions: This study suggests that ESRD is associated with higher rates of several early postoperative complications and mortality following head and neck free flap surgery when controlling for demographics and other comorbidities. Level of Evidence: Level III, risk / prognostic study.