Non-Cochrane · prognostic · PM42343306
Incidence and risk factors for postoperative vascular crisis in patients with oral and maxillofacial cancer: a systematic review and meta-analysis.
Liang Jiahui, He Zhiqiang, Luo Min, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-08961-9
Findings
42 findings
| Population | ||||
|---|---|---|---|---|
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | None (pooled incidence of postoperative vascular crisis) | Not applicable | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Trim-and-fill adjusted (9 imputed studies) | Pooled incidence (%) 19.6 [15.1, 24.0] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | None (pooled incidence of postoperative vascular crisis) | Not applicable | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Publication year: 2020 or earlier | Pooled incidence (%) 10.66 [5.31, 16.01] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | None (pooled incidence of postoperative vascular crisis) | Not applicable | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Overall (random effects, DerSimonian-Laird) | Pooled incidence (%) 14.41 [10.23, 18.59] GRADE not reported 27 studies |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | None (pooled incidence of postoperative vascular crisis) | Not applicable | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Study design: prospective | Pooled incidence (%) 7.25 [2.31, 12.19] GRADE not reported 3 studies |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | None (pooled incidence of postoperative vascular crisis) | Not applicable | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Study design: retrospective | Pooled incidence (%) 15.31 [10.53, 20.09] GRADE not reported 24 studies |
| Patients with oral and maxillofacial malignant tumors undergoing surgery with flap reconstruction | Not applicable (pooled incidence) | Not applicable | Incidence of postoperative vascular crisis Postoperative (diagnostic windows varied: 72 h, 3 days or 7 days) · Hospital-based flap reconstruction after oral and maxillofacial tumor surgery · Sensitivity analysis: leave-one-out, Ishimaru 2016 omitted Unresolved: the two extractors disagree on this row. | Pooled incidence (proportion) 0.14 GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | None (pooled incidence of postoperative vascular crisis) | Not applicable | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Publication year: after 2020 | Pooled incidence (%) 16.11 [10.31, 21.91] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | None (pooled incidence of postoperative vascular crisis) | Not applicable | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Country: non-China | Pooled incidence (%) 5.23 [1.75, 8.71] GRADE not reported 4 studies |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | None (pooled incidence of postoperative vascular crisis) | Not applicable | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Country: China | Pooled incidence (%) 16.08 [11.06, 21.11] GRADE not reported 23 studies |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Diabetes or abnormal blood sugar | No diabetes | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Publication year: after 2020 (fixed effect) | OR 6.71 [4.22, 10.65] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Diabetes or abnormal blood sugar | No diabetes | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Sensitivity analysis (fixed-effect model) | OR 1.88 [1.67, 2.11] GRADE not reported 14 studies · 4547 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Diabetes or abnormal blood sugar | No diabetes | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Trim-and-fill adjusted (7 imputed studies) | OR 1.75 [1.48, 2.03] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Diabetes or abnormal blood sugar | No diabetes | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Publication year: 2020 or earlier (fixed effect) | OR 1.72 [1.52, 1.94] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Diabetes or abnormal blood sugar | No diabetes | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Country: China (random effects) | OR 3.45 [2.40, 4.96] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Diabetes or abnormal blood sugar | No diabetes | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (random-effect model) | OR 3.08 [2.23, 4.24] GRADE not reported 14 studies · 4547 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Diabetes or abnormal blood sugar | No diabetes | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Country: non-China | OR 1.80 [1.18, 2.75] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Oral infection | No oral infection | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Publication year: after 2020 (fixed effect) | OR 14.16 [6.89, 29.07] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Oral infection | No oral infection | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (random-effect model) | OR 4.59 [2.71, 7.78] GRADE not reported 9 studies · 836 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Oral infection | No oral infection | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Publication year: 2020 or earlier (random effects) | OR 1.83 [0.94, 3.58] GRADE not reported Studies not reported |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Oral infection | No oral infection | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Sensitivity analysis (fixed-effect model) | OR 1.82 [1.60, 2.08] GRADE not reported 9 studies · 836 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Decreased fibrinogen (reported as elevated fibrinogen in Table 1 legend) | Normal fibrinogen | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Sensitivity analysis (fixed-effect model) | OR 1.34 [1.22, 1.46] GRADE not reported 3 studies · 542 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Decreased fibrinogen (reported as elevated fibrinogen in Table 1 legend) | Normal fibrinogen | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (random-effect model) | OR 2.02 [1.03, 3.95] GRADE not reported 3 studies · 542 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | History of alcohol abuse | No history of alcohol abuse | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 1.83 [1.19, 2.82] GRADE not reported 2 studies · 1011 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | History of alcohol abuse | No history of alcohol abuse | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Sensitivity analysis (random-effect model) | OR 2.50 [0.78, 8.00] GRADE not reported 2 studies · 1011 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Low albumin (ALB) level | Normal ALB level | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 1.54 [1.27, 1.87] GRADE not reported 3 studies · 416 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Low albumin (ALB) level | Normal ALB level | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Sensitivity analysis (random-effect model) | OR 2.46 [1.01, 6.00] GRADE not reported 3 studies · 416 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | ALB < 35 g/L | ALB >= 35 g/L | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 4.52 [1.91, 10.74] GRADE not reported 2 studies · 169 participants |
| Patients with oral and maxillofacial malignant tumors undergoing surgery with flap reconstruction | Risk factor: Albumin below 35 g/L | Absence of the factor | Postoperative vascular crisis Postoperative (diagnostic windows varied: 72 h, 3 days or 7 days) · Hospital-based flap reconstruction after oral and maxillofacial tumor surgery · Sensitivity analysis: random-effects model | OR 4.52 [1.91, 10.74] GRADE not reported 2 studies · 169 participants |
| Patients with oral and maxillofacial malignant tumors undergoing surgery with flap reconstruction | Risk factor: Fewer than 2 anastomotic veins | Absence of the factor | Postoperative vascular crisis Postoperative (diagnostic windows varied: 72 h, 3 days or 7 days) · Hospital-based flap reconstruction after oral and maxillofacial tumor surgery · Sensitivity analysis: random-effects model | OR 1.74 [1.26, 2.41] GRADE not reported 2 studies · 491 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Fewer than 2 venous anastomoses | 2 or more venous anastomoses | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 1.74 [1.26, 2.41] GRADE not reported 2 studies · 491 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | History of smoking | No history of smoking | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Sensitivity analysis (random-effect model) | OR 1.74 [1.17, 2.61] GRADE not reported 3 studies · 921 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | History of smoking | No history of smoking | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 1.55 [1.39, 1.74] GRADE not reported 3 studies · 921 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Preoperative radiotherapy | No preoperative radiotherapy | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Sensitivity analysis (random-effect model) | OR 2.37 [1.56, 3.60] GRADE not reported 3 studies · 935 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Preoperative radiotherapy | No preoperative radiotherapy | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 2.31 [1.61, 3.33] GRADE not reported 3 studies · 935 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Surgical history in the recipient area | No surgical history in the recipient area | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 3.13 [1.47, 6.67] GRADE not reported 2 studies · 478 participants |
| Patients with oral and maxillofacial malignant tumors undergoing surgery with flap reconstruction | Risk factor: Surgical history of the recipient area | Absence of the factor | Postoperative vascular crisis Postoperative (diagnostic windows varied: 72 h, 3 days or 7 days) · Hospital-based flap reconstruction after oral and maxillofacial tumor surgery · Sensitivity analysis: random-effects model | OR 3.13 [1.47, 6.67] GRADE not reported 2 studies · 478 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Age < 60 years | Reference age group not stated | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (random-effect model) | OR 4.15 [0.41, 42.18] GRADE not reported 2 studies · 144 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Age < 60 years | Reference age group not stated | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Sensitivity analysis (fixed-effect model) | OR 1.75 [1.44, 2.12] GRADE not reported 2 studies · 144 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Hypertension | No hypertension | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 10.46 [2.13, 51.33] GRADE not reported 2 studies · 109 participants |
| Patients with oral and maxillofacial malignant tumors undergoing surgery with flap reconstruction | Risk factor: Hypertension | Absence of the factor | Postoperative vascular crisis Postoperative (diagnostic windows varied: 72 h, 3 days or 7 days) · Hospital-based flap reconstruction after oral and maxillofacial tumor surgery · Sensitivity analysis: random-effects model | OR 10.46 [2.13, 51.33] GRADE not reported 2 studies · 109 participants |
| Patients with oral and maxillofacial malignant tumors undergoing surgery with flap reconstruction | Risk factor: Male sex | Female sex | Postoperative vascular crisis Postoperative (diagnostic windows varied: 72 h, 3 days or 7 days) · Hospital-based flap reconstruction after oral and maxillofacial tumor surgery · Sensitivity analysis: random-effects model | OR 7.26 [2.68, 19.67] GRADE not reported 2 studies · 440 participants |
| Patients with oral and maxillofacial malignant tumors undergoing free flap reconstruction | Male sex | Female sex | Postoperative vascular crisis Free flap reconstruction after surgery for oral and maxillofacial cancer · Main analysis (fixed-effect model) | OR 7.26 [2.68, 19.67] GRADE not reported 2 studies · 440 participants |
Included primary studies 27
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Wang 2020 matched by author and year (probable) | NR | 5 other reviews | Postoperative vascular crisis | not extracted yet |
| Chen 2023 matched by author and year (probable) | NR | 4 other reviews | Postoperative vascular crisis | not extracted yet |
| Zhang 2022 matched by author and year (probable) | NR | 2 other reviews | Postoperative vascular crisis | not extracted yet |
| Zhang 2021 matched by author and year (probable) | NR | 1 other review | Postoperative vascular crisis | not extracted yet |
| Zhou 2022 matched by author and year (probable) | NR | 1 other review | Postoperative vascular crisis | not extracted yet |
| Chen 2020 DOI:10.12144/zgmfskin202005285 | NR | this review only | Postoperative vascular crisis | not extracted yet |
| Hennocq 2025 Prognostic Factors for Free Flap Failure in Head and Neck Reconstruction DOI:10.1002/hed.28095 | 2025 | this review only | not stated | not extracted yet |
| Hennocq 2025 Prognostic Factors for Free Flap Failure in Head and Neck Reconstruction. PMID:39912543 | 2025 | this review only | Postoperative vascular crisis | not extracted yet |
| Ishimaru 2016 Risk Factors for Free Flap Failure in 2,846 Patients With Head and Neck Cancer: A National Database Study in Japan DOI:10.1016/j.joms.2016.01.009 | 2016 | this review only | not stated | not extracted yet |
| Ishimaru 2016 Risk Factors for Free Flap Failure in 2,846 Patients With Head and Neck Cancer: A National Database Study in Japan. PMID:26851310 | 2016 | this review only | Postoperative vascular crisis | not extracted yet |
| Li 2023 (Li C) DOI:10.3969/j.issn.2096-2665.2023.09.030 | NR | this review only | Postoperative vascular crisis | not extracted yet |
| Ouyang 2024 Comprehensive analysis of risk factors for flap necrosis in free flap reconstruction of postoperative tissue defects in oral and… DOI:10.1038/s41598-024-69159-z | 2024 | this review only | not stated | not extracted yet |
| Ouyang 2024 Comprehensive analysis of risk factors for flap necrosis in free flap reconstruction of postoperative tissue defects in oral and… PMID:39134569 | 2024 | this review only | Postoperative vascular crisis | not extracted yet |
| Panda 2023 Pectoralis Major Myocutaneous Flap Reconstruction for Oromandibular Defects: Analysis of Predictors for Optimum Reconstructive Outcome DOI:10.5152/b-ent.2023.231366 | 2023 | this review only | Postoperative vascular crisis | not extracted yet |
| Shang 2023 matched by author and year (probable) | NR | this review only | Postoperative vascular crisis | not extracted yet |
| Sun 2025 Risk factors for postoperative vascular crisis in squamous cell carcinoma reconstruction using supraclavicular artery flaps. PMID:40667552 | 2025 | this review only | Postoperative vascular crisis | not extracted yet |
| Tsai 2025 Risk Factors of Free Flap Outcomes After Head and Neck Cancer Surgery: A Multivariable Analysis From a Single Center Experience DOI:10.1002/micr.70023 | 2025 | this review only | not stated | not extracted yet |
| Tsai 2025 Risk Factors of Free Flap Outcomes After Head and Neck Cancer Surgery: A Multivariable Analysis From a Single Center Experience. PMID:39921587 | 2025 | this review only | Postoperative vascular crisis | not extracted yet |
| Wilson 2024 Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction DOI:10.1016/j.bjoms.2024.05.016 | 2024 | this review only | not stated | not extracted yet |
| Wilson 2024 Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction. PMID:39317564 | 2024 | this review only | Postoperative vascular crisis | not extracted yet |
| Yu 2024 Predictive factors of postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to… DOI:10.1186/s12871-024-02649-9 | 2024 | this review only | not stated | not extracted yet |
| Yu 2024 Predictive factors of postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to… PMID:39075344 | 2024 | this review only | Postoperative vascular crisis | not extracted yet |
| Zheng 2022 matched by author and year (probable) | NR | this review only | Postoperative vascular crisis | not extracted yet |
| Zheng 2024 Development and validation of a predictive nomogram for vascular crises in oral and maxillofacial cancer patients undergoing free flap… DOI:10.1371/journal.pone.0314676 | 2024 | this review only | not stated | not extracted yet |
| Zheng 2024 Development and validation of a predictive nomogram for vascular crises in oral and maxillofacial cancer patients undergoing free flap… PMID:39630781 | 2024 | this review only | Postoperative vascular crisis | not extracted yet |
| Zhou 2017 Risk factors for free flap failure: a retrospective analysis of 881 free flaps for head and neck defect reconstruction DOI:10.1016/j.ijom.2017.03.023 | 2017 | this review only | not stated | not extracted yet |
| Zhou 2017 Risk factors for free flap failure: a retrospective analysis of 881 free flaps for head and neck defect reconstruction. PMID:28416356 | 2017 | this review only | Postoperative vascular crisis | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with oral and maxillofacial malignant tumors (oral cancer); head and neck cancer studies used only if oral cancer data could be extracted | 27 studies (23 from China; UK, France, Japan, India one each); patients with oral and maxillofacial tumors after free or pedicled flap reconstruction |
| Intervention | Influencing (risk) factors of postoperative vascular crisis | 44 influencing factors identified; 13 factors reported in at least two studies were pooled |
| Comparison | Absence of the factor | Absence of the factor (female sex for male sex) |
| Outcomes | Incidence of postoperative vascular crisis and its influencing factors (odds ratios) | Pooled incidence of vascular crisis 14.41% (27 studies); 12 factors significantly associated (diabetes, hypertension, oral infection, low fibrinogen, low ALB, ALB < 35 g/L, preoperative radiotherapy, recipient-site surgical history, fewer than 2 anastomotic veins, alcohol abuse, smoking, male sex) |
| Study designs | Original cross-sectional, case-control and cohort studies; Chinese or English; Newcastle-Ottawa Scale score of 6 or more | 3 prospective cohort studies, remaining retrospective (2 matched case-control); NOS scores 6 to 8 |
| Timing | Not specified | Postoperative; diagnostic windows 72 h, 3 days or 7 days; 12 studies gave no definition; studies published 2014 to 2025 |