ORIGINAL RESEARCH article
Front. Oncol.
Sec. Head and Neck Cancer
Perioperative laboratory profiles predict complications after extensive head and neck reconstruction: A proof-of-concept study
Provisionally accepted
Tatjana Khromov1*
Simon Breier1Ulrich Stefenelli2Boris Schminke1Julie Schanz1Andreas Fischer1,3Henning Schliephake1
Phillipp Brockmeyer1- 1University Medical Center Göttingen, Göttingen, Germany
- 2Chi2 data analytics and artificial intelligence GmbH, Wuerzburg, Germany
- 3Universitatsklinikum Mannheim, Mannheim, Germany
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Surgical reconstruction of head and neck defects after oncological resection is a complex procedure often associated with unpredictable postoperative complications. Hence, laboratory parameter profiles are of considerable interest as potential perioperative predictors. This retrospective study analyzed a comprehensive set of laboratory parameters in 233 patients with oral squamous cell carcinoma (OSCC) who underwent tumor resection and reconstruction. The overall complication rate was 30%, with wound dehiscence (12.4%), pulmonary embolism (PE, 11.6%), and surgical revision (10.3%) being the most common complications. Dynamic analysis of perioperative laboratory parameters from one week before to 49 days after surgery revealed that patients who developed complications showed less pronounced decreases in hemoglobin, hematocrit, and erythrocyte levels. These patients also exhibited altered coagulation and electrolyte profiles. Statistical analysis using logistic regression identified hematocrit slope as independent predictor. Meanwhile, random forest modeling highlighted INR and aPTT as key markers. Subgroup analysis showed that PE, the most clinically significant complication, was associated with abnormal potassium, urea, and protein profiles. Whereas a therapy-related increase in aPTT was observed postoperatively, INR alterations were already evident preoperatively. Conversely, local complications such as wound dehiscence, surgical revision, and graft failure were more strongly associated with deteriorating hematological parameters. Given their multifactorial nature, influenced by comorbidities, tumor biology, and perioperative management, these findings highlight the need for longitudinal laboratory monitoring and prospective validation in controlled settings. Integrating dynamic laboratory trends into multimodal prediction models may facilitate earlier risk stratification and improve individualized perioperative management in head and neck reconstructive surgery.
Keywords: Head and Neck surgery, perioperative laboratorytrends, Postoperative Complications, Reconstructive and plastic surgery, risk stratification
Received: 14 Oct 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Khromov, Breier, Stefenelli, Schminke, Schanz, Fischer, Schliephake and Brockmeyer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tatjana Khromov
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