Risk factors for postop ventilation following free flap reconstruction
Reviewed by Stuart Clark

This study, conducted in the United States, analysed 144 patients undergoing free flap surgery. Of these, 51 patients were extubated within 48 hours postoperatively, while 93 remained intubated for more than 48 hours. The mean duration of ventilation was 36 hours for the early extubation group versus 249 hours for the prolonged group. Patients requiring extended ventilation had higher rates of return to the operating room, longer intensive care unit stays and overall increased hospital length of stay. Tongue reconstructions had the longest mean hospital stay, whilst current smoking and an ASA (American Society of Anesthesiologists) score of 3 or 4 were significant risk factors for prolonged mechanical ventilation. The study highlights that the cumulative burden of comorbidities, as reflected in higher ASA scores, is more relevant than individual system-specific conditions. Discharge from the hospital was noted to be a complex issue with other compounding factors. The authors also observed an association between prolonged intubation and the need for a second surgical procedure.

Risk factors for prolonged postoperative mechanical ventilation following head and neck microvascular free flap reconstruction and its association with patient outcomes. 
Mosquera C, Velazques R, Weyh AM, et al.
INT J ORAL MAXILLOFAC SURG 
2025;54(9):809–15.