Rates of ICU Delirium After Microvascular Free Tissue Transfer Reconstruction of the Oral Cavity and Oropharynx

Background: Microvascular free tissue transfer (MFTT) is the standard in the reconstruction of major head and neck defects, but involves extended hospital stays and an increased risk of post-operative delirium (POD). What risk factors increase the risk of POD in patients undergoing MFTT, and subsequent complications?. Methods: Retrospective cohort study of 168 patients undergoing MFTT following ablation of oral cavity or oropharyngeal cancer. Patient demographic data, operative data, post-operative ventilatory support needs, post-operative complications, and post-operative sedation and analgesic needs were collected, and the association with POD was evaluated. Results: POD was significantly associated with opioid (p = 0.0018) and sedation requirements (p < 0.001), postoperative return to the OR (p = 0.002) and medical complications (p = 0.033). There was no association with the rate of MFTT failure (p > 0.05). Conclusion: In MFTT patients, opioid and sedative administration are potentially modifiable factors that may be able to reduce POD incidence and optimize the postoperative course of patients undergoing MFTT.