Facial Reanimation Procedures: An ACS-NSQIP-Driven Review of Perioperative Outcomes and Risk Factors
Luis Antezana, MD1, Khaled Alammedine, MD1, Cole Holan, MD, MBA1 and Jorys Jorge Martinez, MD2, 1Mayo Clinic, Rochester, MN, 2Mayo Clinc, Rochester, MN
Background: Over the past century, facial paralysis repair techniques have ranged from static sling procedure to most recently cross-face nerve grafting in addition to free flap advancements. Despite the rise in popularity, large database reviews on postoperative morbidity and risk factor analysis remains.
Objectives: This study is a retrospective analysis of perioperative outcomes and risk factors related to facial reanimation procedures – both static and dynamic. The multi-institutional database - American College of Surgeons National Surgical Quality Improvement Program Database (ACS-NSQIP) – was utilized for extract of variables.
Methods: The ACS NSQIP database (2015-2023) was reviewed to identify patients would had facial reanimation procedures (namely three categories nerve-driven repairs, non-nerve or sling type repairs, and concomitant procedures). CPT codes associated with each category were used to extract patient data. Variables collected included postoperative outcomes (e.g. reoperation, readmission, mortality, and 30-day complications – medical and surgical). Risk factors associated with complications were also gathered.
Results: Among 1,290 patients (62.1% male, mean age 63±14 years) that received facial reanimation surgeries, 589 (45.7%; 95% CI, 42.8%-48.6%) had nerve-driven repairs, 442 (34.3%; 95% CI, 31.6%-37.1%) received sling-type repairs, and 259 (20%; 95% CI, 17.9%-22.2%) underwent a combination. Notably, younger patients predominantly underwent nerve-driven repairs compared to their older counterparts who had sling-type repairs (mean age, 58.7±15.3 vs 70.2±12.6 years; P<.001). Additionally, of the 315 patients who received free tissue reconstruction, a significant majority (51.7%) had simultaneous facial reanimation surgeries, markedly more than those without free tissue reconstruction (292 of 975 [30%; P=.002]). Variables with a p-value <0.1 in the univariate analysis, along with known risk factors, were included in a multivariate logistic regression model. Notably, smoking (odds ratio [OR] = 2.35, 95% confidence interval [CI] 1.25-4.42, p = 0.008) and diabetes (OR = 3.92, 95% CI 1.45-10.57, p = 0.007) emerged as significant independent predictors of 30-day postoperative complications. Concurrent free tissue reconstruction also demonstrated a significant association with increased complications (OR = 1.68, 95% CI 1.11-2.53, p = 0.015). Conversely, younger age (OR = 0.97 per year, 95% CI 0.95-0.99, p = 0.003) was found to be a protective factor against complications.
Conclusions: Patients who underwent free tissue reconstruction had a higher likelihood of simultaneous facial reanimation surgeries, and this group exhibited increased postoperative complications. Smoking, diabetes, and concurrent free tissue reconstruction were identified as significant independent predictors of 30-day postoperative complications, while younger age was a protective factor.
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