Efficacy of Aspirin Usage in Free Flap Reconstruction of the Head and Neck

ABSTRACT Objective To compare head and neck free flap outcomes and complications following aspirin administration. Methods This is a multicenter, retrospective cohort study using data from the 107 healthcare organizations in the United States. Adult patients (≥ 18 years) with a history of head and neck cancer who received non‐bony or bony free flap reconstruction were included. They were grouped by receiving 81 mg of aspirin (ASA81), 325 mg of aspirin (ASA325), or no aspirin on the same day of surgery or postoperatively. Primary outcomes included free flap failure, blood vessel repair, and need for flap revision. Relative risks (RR) with 95% confidence intervals (95% CI) were evaluated. Subgroup analysis was conducted between ASA81 and ASA325. Results No differences in primary outcomes were observed for same day administration of aspirin. Postoperatively, ASA81 reduced the risk of flap failure and needing a blood vessel repair procedure (RR: 0.650.49–0.86; 0.520.42–0.65). ASA325 was also associated with a decreased risk of flap failure, need for blood vessel repair, and the need for flap revision procedures (RR: 0.100.08–0.13; 0.570.46–0.71; 0.370.32–0.41) for all flap types. For non‐bony reconstruction, all primary outcomes were lower in the ASA81 group (RR: 0.720.53–0.98; 0.530.41–0.68; 0.730.59–0.89). ASA325 for non‐bony flaps was also associated with lower rates of all three primary outcomes (RR: 0.470.34–0.64; 0.630.49–0.80; 0.800.68–0.94). Aspirin use in bony flaps was associated with similar outcomes. ASA81 compared to ASA325 for non‐bony reconstruction was associated with higher flap failure (RR: 1.691.16–2.46). Conclusion For non‐bony and bony free flap reconstruction, aspirin was associated with decreased risks of free flap failure, blood vessel repair, and flap revision.