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 technique 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 a variety of databases for articles on microvascular free tissue transfer surgery using aspirin published between 2007 and 2022 and assessed them for primary and secondary outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined through analyses, followed by the construction of a forest plot for complication rates. A total 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 complication rates of 38%, the highest among all reported studies. The ORs between the studies for complications and flap survival rates were 2.614 and 0.722, respectively. Although the complication rates associated with aspirin use were not significantly higher among the studies, though they cannot be ignored. Flap survival rates were independent of the dose and type of anticoagulants used during surgery.