Abstract
PURPOSE: This study examined the relationship between perioperative dexmedetomidine exposure and postoperative flap outcomes following head and neck reconstruction. METHODS: This cohort study used the TriNetX Research Network to identify adults who underwent head and neck flap reconstruction for malignancy between 2014 and 2024. Perioperative dexmedetomidine exposure and outcomes were ascertained using medication records and Current Procedural Terminology (CPT) codes. Following matching, 2,522 patients per group were analyzed. The primary outcome was flap failure within 30 days of surgery. Secondary outcomes included 30-day blood vessel repair procedures, other flap revisions, mortality, acute kidney injury, and sepsis. Analyses at 14 and 90 days were exploratory. RESULTS: For the primary outcome, the dexmedetomidine group demonstrated lower flap failure rates compared with controls at 30 days (2.6% versus 4.1%; odds ratio [OR] 0.62, 95% confidence interval [CI] 0.45-0.85). Among secondary outcomes, a similar association was observed for blood vessel repair procedures (5.4% vs 7.7%; OR 0.69, 95% CI 0.55-0.87). No significant differences were observed in other outcomes. Exploratory temporal analyses revealed directionally consistent associations at 14 days (flap failure OR 0.54, 95% CI 0.37-0.79) and 90 days (flap failure OR 0.66, 95% CI 0.50-0.87). Sensitivity analyses excluding perioperative blood transfusion recipients and restricting the study to tertiary centers demonstrated directional consistency with the primary findings. Multivariable regression identified dexmedetomidine as independently associated with reduced flap failure (hazard ratio 0.60, 95% CI 0.46-0.78). CONCLUSION: Perioperative dexmedetomidine exposure is associated with reduced flap failure and blood vessel repair, supporting the need for prospective randomized trials.