DECREASING THE PERIOPERATIVE COMPLICATIONS ASSOCIATED WITH THE SUPERIOR PHARYNGEAL FLAP OPERATION

This outcome study was a continuation of a previously published review . It examined whether there has been a decrease in the number of acute perioperative complications surrounding superior pharyngeal flap oper ations since a patient's death in 1990. A total of 386 patients were d ivided into two groups: the early group (July of 1985 to December of 1 990) n = 164, and the later group (January of 1991 to June of 1996) n = 222, which were statistically comparable. The patient complication r ate decreased from 19.5 to 6.3 percent (chi square, p = 0.0001). Airwa y obstruction decreased from 11 to 3.2 percent (chi square, p = 0.0012 ). Bleeding complications decreased from 7.3 to 1.4 percent (chi squar e, p = 0.0027). The majority of airway complications (72 percent) and bleeding complications (80 percent) occurred in the first 24 hours. Pr edictive factors for complications included the surgeon involved, pati ents with associated medical conditions, having an associated procedur e performed concurrently, and leaving the donor site open (multiple lo gistic regression). Hospital stay also decreased from 5.8 +/- 2.5 to 3 .8 +/- 1.6 days (Student's t test p = 0.0001). The decrease in complic ation rate was due to the increased awareness of all staff involved an d also due to changes in surgical management, including a decrease in the number of surgeons (from seven to four surgeons), a decrease in th e number of associated procedures (10.4 to 4.5 percent, chi square, p = 0.026), a decrease in the number of open donor sites (34.8 to 4.5 pe rcent, chi square, p = 0), and an increase in the use of nasopharyngea l airways (17.1 to 45 percent, chi square, p = 0). The superior pharyn geal flap operation has become a safer procedure in this hospital.