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Intraoperative use of vasopressors is safe in head and neck free tissue transfer
Edward W. Swanson, MD1, Hsu-Tang Cheng, MD2, Srinivas M. Susarla, DMD, MD, MPH1, Georgia C. Yalanis, BS, MSc1, Denver M. Lough, MD, PhD1, Owen Johnson, III, MD1, Anthony P. Tufaro, DDS, MD1, Paul N. Manson, MD1, Justin M. Sacks, MD1.
1The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2The Johns Hopkins University School of Medicine and China Medical University School of Medicine, Baltimore and Taichung City, MD, USA.

BACKGROUND: The purpose of this study is to identify whether intraoperative use of vasoactive medications increases the risk of free flap failure or complications through a systematic review and meta-analysis.
METHODS: PubMed/MEDLINE, EMBASE, and SCOPUS databases were searched for studies published through January 2015. English publications that met the following criteria were included: (1) adult patients undergoing head and neck free flap reconstruction; (2) comparison of patients with and without intraoperative vasopressor administration; (3) documentation of flap failure rate and/or flap complications. The primary outcome was the incidence of flap failure. The secondary outcome was the incidence of overall flap complications. Meta-analysis was performed to obtain pooled odds ratios (OR) of the effect of intraoperative use of vasopressors on flap failure and complication rates.
RESULTS: Four cohort studies met inclusion criteria (Figure 1). All studies were of high methodological quality with an average MINORS score of 18.75 (range 16 - 23). A total of 933 patients undergoing head and neck free flap reconstruction were included. Meta-analysis demonstrated no statistically significant difference in the incidence of flap failure (2.9% vs. 3.6%; OR: 0.68, 95% CI: 0.23-1.99; p= 0.48; Figure 2) or incidence of flap complications (16.8% vs. 18.6%; OR: 0.92, 95% CI: 0.60-1.42; p= 0.71; Figure 3).
CONCLUSIONS: Based on the current evidence, intraoperative use of vasopressors has no impact on the incidence of flap failure or flap complications.

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