Postoperative outcomes of aspirin in microvascular free tissue transfer surgery-A systematic review and meta-analysis

Microvascular free tissue transfer surgery is a frequently used tech-nique for head and neck reconstruction involving anticoagulants, and the present study aimed to analyse the postoperative outcomes of aspirin use in conjunction with this procedure. We searched databases for articles published between 2007 and 2022 on mi-crovascular free tissue transfer surgery using aspirin and assessed them for primary and secondary outcomes. Odds ratios (ORs) and 95 % confidence intervals (CIs) were determined through analyses, followed by constructing a forest plot for complication rates. A to-tal of 617 articles were retrieved from the databases, including 14 original full-text articles. Overall complication rates ranged from 0.7-38 % (95 % CI, 17.85 +/- 0.503 ( +/- 2.8 %) [17.347-18.353]), while flap survival rates ranged from 95-99.2 % (95 % CI, 96.28 +/- 0.0956 ( +/- 0.10 %) [96.184-96.376]). Two studies reported similar complica-tion rates of 38 %, the highest among all reported studies. The ORs between the studies for the complications and flap survival rates were 2.614 and 0.722, respectively. Although the complication rates associated with aspirin use were not significantly high among the studies, they cannot be ignored. Flap survival rates were indepen-dent of the dose and type of anticoagulants used during surgery. (c) 2023 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )