Klinikum Nürnberg

Zusammenfassung Im deutschen Gesundheitswesen sind die Vergütungen der stationären und der ambulanten Patientenversorgung klar voneinander abgegrenzt. Die Abrechnung im stationären Bereich erfolgt über Fallpauschalen im Rahmen der Diagnosis-Related Groups (DRG). Um bestehende Ambulantisierungspotenziale bei bislang stationär erbrachten Leistungen zu steigern, wurden sogenannte Hybrid-DRGs festgelegt, die eine spezielle sektorgleiche Vergütung ermöglichen sollen. 2024 wurden zwölf Hybrid-DRGs, festgelegt, und ab 2025 stehen weitere zehn Hybrid-DRGs zur Verfügung. Die Leistungen der Schlafmedizin sind jedoch bislang nicht als Hybrid-DRG abgebildet. Die Deutsche Gesellschaft für Schlafforschung und Schlafmedizin e. V. (DGSM) legt mit diesem Positionspapier die bisherige Leistungserbringung und die Erlössituation beispielhaft für die Diagnose und Therapie der schlafbezogenen Atmungsstörungen dar, um die Diskussionsgrundlage für die Verhandlungspartner und Entscheidungsträger der Selbstverwaltung zu schaffen und somit die Grundlage für eine sektorengleiche Vergütung bzw. Hybrid-DRG unter Wahrung einer sicheren und hochwertigen Patientenversorgung zu legen.

Recognizing skilful group members is crucial for making optimal social choices. Whether and how nonhuman animals attribute skill to others is still debated. Using a lever-operated food box, we enhanced the foraging skill of a single male (the specialist) in one zoo-housed and two wild groups of Guinea baboon (Papio papio). We measured group members' behavioural responses before, during and after our manipulation to reveal whether they focused on the outcome of the male's actions or changed their assessment of his long-term value. During the manipulation, females in the specialist’s unit, but not the wider group, competed over access to the specialist—increasing their grooming of him 10-fold and aggression near him fourfold. Both behaviours were predicted by the amount each female ate from the food box and returned to baseline within 2 weeks of its removal. This behavioural pattern supports an outcome-based assessment where females responded to male-provided benefits (utility) rather than attributing competence (value). By contrast, males from the wider party ate prodigiously from the reward but did not change their behaviour towards the specialist at all—revealing different social strategies corresponding to the social stratification of the Guinea baboon’s multi-level society.

IKZF1 mutations are recurrent alterations in acute myeloid leukaemia (AML), and hotspot point mutation, N159S, has recently been associated with unique gene expression and adverse risk. To better understand the molecular and clinical associations of IKZF1 N159S‐mutated AML, we performed a pooled analysis of 4136 AML patients. IKZF1 N159 mutations were found in 39 patients (0.94%) in a dominant clonal constellation, indicating early genetic events. N159S mutations were associated with aberrant karyotype, significantly higher rates of myelodysplasia‐related gene mutations, ELN2022 adverse risk and a particularly poor outcome, supporting the classification of IKZF1 N159S‐mutated AML as a rare molecular subtype with adverse prognosis.

In three girls, aged 14, 15 and 16 years, the chromosome analysis revealed a morphologically abnormal, enlarged X-chromosome resembling in size and centromere position the chromosome no. 2. The translocation points were different in all three cases. The Barr-bodies were enlarged. In two girls a 45,X mosaicism (25% and 10%) was found in lymphocyte cultures. The length at birth was 43, 47 and 48 cm, and none of the girls was born before term. The main clinical abnormalities in all three cases were a marked growth retardation, slight morphological dysplasias, lack of sexual development and social immaturity. GH and Cortisol secretion during an insulin tolerance test were normal. LH and FSH were elevated and showed an exaggerated reaction on LH-RH. Oestrogens were low normal and androgens within the normal range. At laparatomy the gonads were found to be streak gonads. For two girls cell cultures of gonadal tissue were set up? the chromosome findings of which corresponded to those of the lymphocyte cultures. The abnormality of the gonosomes reported here seems to represent a special form of gonadal dysgenesis. Although the translocation points were different in the three patients and one had no mosaic, while the other two showed 45,X/46,XX mosaicism, the clinical and hormonal findings were nearly the same for all three girls.

Background and purpose In the differential diagnostic workup of amyotrophic lateral sclerosis (ALS), magnetic resonance imaging (MRI) is primarily used to rule out significant differential diagnoses. So far, whole-brain T1-mapping has not been assessed as a diagnostic tool in this patient population. Methods We investigated the diagnostic potential of a novel T1-mapping method based on real-time MRI with 0.5 mm in-plane resolution and 4s acquisition time per slice. The study included patients aged 18 to 90 years who met the revised El Escorial criteria for at least possible ALS. T1-relaxation times were measured along the corticospinal tract in predefined regions of interest. Results Twenty-nine ALS-patients and 43 control group patients (CG) were included in the study. Median ALS Functional Rating Scale revised (ALSFRS-R) was 37 (IQR, 35–44) points and the mean duration from symptom onset to MRI was 21 ± 17 (SD) months. ALS patients showed significantly higher T1-relaxation times in all ROIs compared to CG with mean differences in the hand knob of 50 ms ( p < 0.001), corona radiata 24 ms ( p = 0.034), internal capsule 27 ms ( p = 0.002) and midbrain peduncles 48 ms ( p < 0.001). There was a consistent negative correlation between the ALSFRS-R and T1-relaxation times in all ROIs. Conclusions T1-relaxation times along the corticospinal tract are significantly elevated in ALS patients compared to CG and associated with lower ALSFRS-R. These results imply the analysis of T1-relaxation times as a promising diagnostic tool that can distinguish ALS patients from the control group. Ongoing longitudinal studies may provide deeper insights into disease progression and the effects of therapeutic interventions.

OBJECTIVES Diabetes mellitus is a risk factor for coronary artery disease, but its role following CABG is still unclear and few data on long-term outcomes are available. This study aimed to evaluate the impact of diabetes on long-term outcomes after CABG. METHODS The PRIORITY project is an observational cohort study merging two prospective multicentre studies on isolated CABG. Follow-up information was obtained through administrative databases and was truncated 10 years after the intervention. Baseline differences between patients with and without diabetes were balanced with inverse probability of treatment weighting. RESULTS The cohort consisted of 10,989 patients with complete follow-up information who underwent isolated CABG (diabetes 32.3%). Diabetes did not affect short-term mortality (OR 0.90, 95% CI 0.73–1.10) and repeat revascularization (OR 0.79, 95% CI 0.42–1.49), while it is related to lower incidence of 30-day MACCE (OR 0.67, 95% CI 0.60–0.76), AMI (OR 0.60, 95% CI 0.51–0.70) and stroke (OR 0.47, 95% CI 0.28–0.77). Diabetic patients had a higher long-term risk for MACCE (weighted HR 1.31, 95% CI 1.26–1.37), mortality (HR 1.45, 95% CI 1.37–1.53), as well as stroke (HR 1.38, 95% IC 1.25–1.53) and myocardial infarction (HR 1.39, 95% CI 1.26–1. 53). Diabetes had not been associated with an increased incidence of repeated revascularization up to 10 years (HR 1.04, 95%IC 0.96–1.12). CONCLUSIONS Diabetic patients had worse long-term outcomes. Diabetes may have a greater negative impact on micro-vasculopathy than grafts, as evidenced by the increased long-term incidence of myocardial infarction without affecting myocardial revascularization.

523 Background: Tyrosine kinase (TKI) and immune checkpoint inhibitors (CPI) are first-line options in metastatic renal cell carcinoma (mRCC). Most patients (pts) experience adverse events (AE) and 20-30% discontinue therapies due to AEs. We tested whether proactive onco-coaching (POC) improved quality of life (QoL) in patients with medical treatment. Methods: Adult treatment-naïve mRCC pts who were candidates for sunitinib (SU), axitinib + avelumab (AA) or axitinib + pembrolizumab (AP) were eligible. Treatment and modifications were at the physician's discretion. Pts were 1:1 randomized to POC by a trained nurse (8 visits of structured interviews educating on preventive, preemptive and supportive measures, and phone call follow-up for a total of 24 wks) or standard of care (SOC). Primary endpoint was the fraction of pts with QoL improvement (QOLI) by ≥3 points (minimal important difference: MID) of the FKSI-15 score. Secondary endpoints consisted of patient reported outcomes (PRO: FACT-G, EQ-5D), time to QOLI, efficacy, survival and safety (CTCTAE 4.03). The planned sample size was 430 pts. Log rank analyses were employed for time to event endpoints and Fisher exact tests for categorical data. Results: Between 2016 and 2023, 113 pts were included. Median age was 72 and 68y (POC vs. SOC). 44% had a Charlson Comorbidity Index (CCI) ≥2. MSKCC good/intermediate/poor risk were 21/61/12%. 86% had clear cell histology. Of 110 treated patients, 39% and 61% received SU or AXI-CPI (AA or AP). FKSI-15-completion rate was 85%. 80 pts (73%) had ≥2 PRO assessments and were evaluable for the primary endpoint. There was no difference in QOLI between POC and SOC (43.6% vs. 41.5%; p=0.95). Mean baseline FKSI-15 score was similar between arms, as were ORR (38.2 [95% CI 25.4-52.3] vs. 34.5% [95% CI 22.2-48.6]; p=0.96) and PFS (11.1 [95% CI 8.3- 18.9] vs. 9.2 mo [95% CI 5.6-14.6]; p=0.21). Overall survival was favored by POC (median 49.6 [95% CI 30.6- 61.6] vs. 25.4 mo [95% CI 17.8-NC]; p=0.11). Stratification by CCI had no relevant effect on OS in the POC arm (p=0.26), while pts. with CCI ≥2 had poorest OS in the SOC arm (15.7 vs. 33.4 mo; p=0.002). Treatment related AEs of any or ≥3 grade affected 96.4% and 52.7% with POC and 85.5% and 36.4% with SOC. Discontinuation due to toxicity between POC vs. SOC occurred for TKI in 7.3 vs. 9.1% and for CPI in 18.2 vs. 5.5% pts. Conclusions: Target patient accrual was not reached, and POC did not improve the rate of QoL responders or treatment efficacy. However, there was a trend towards a considerable extension of OS in the POC group, suggesting an overall beneficial impact of proactive coaching compared to standard reactive therapy management. Comorbid patients putatively benefit most from pro-active coaching, which warrants further studies. Clinical trial information: NCT03013946 .

707 Background: Metastatic PC has the lowest survival rate of all malignant diseases and is the fourth most common cancer. QoL remains an unresolved issue in PC for patients (pts) after treatment failure of 1 st -line CTx (TTF1). Nanoliposomal irinotecan (Nal-IRI) with 5-FU/folinic acid (FA) increased survival of PC pts from 4.2 months (mo) to 6.1 mo as compared to 5-FU/FA alone, with a rate of toxicities that may impact QoL. PREDICT is an open label, single arm, multicenter Phase IIIb trial (NCT03468335) and examined 2 nd -line Nal/IRI/5-FU/FA for PC. Here we report on QoL during 2 nd -line Nal-IRI after failure of 1 st -line gemcitabine/nab-Paclitaxel (gem/nab-Pac). Methods: In this prospective trial, 151 patients with locally advanced or metastatic PC were treated with biweekly Nal-IRI/5-FU/FA (70 mg/m², 2400 mg/m², 400 mg/m²) after failure of gem/nab-pac (TTF1). Primary end point (EP) was the time to treatment failure of 2 nd -line therapy (TTF2) and has been reported elsewhere. Secondary EP were QoL and Health related quality of life (HR-QoL) which were evaluated using questionnaires (EORTC QLQC30, QLQ-PAN26, EQ-5D-5L). Evaluation of time to definitive deterioration of QoL (TDD) during 2 nd -line therapy, defined as the time from screening/baseline until loss of ≥10 points in the EORTC QLQ-C30 was compared to baseline. Results: QoL analyses were performed with all QoL evaluable subjects set (QAS). The QAS included 143 pts, of which 48 pts were included in TTF1 high (TTF of 1 st -line ≥213 d) and 49 pts in the TTF1 low (TTF ≤119 d) cohort, with 79 (54.1%) female and 67 (45.9%) male pts. Mean age was 68.2±8.9 years. Overall, a low global health status / QoL mean score was observed at baseline for TTF1 high and low cohorts (about 48 points), which slightly improved during the study for TTF1 high (3.5±23.7) and slightly worsened for TTF1 low cohort (-0.7±22.5). Substantial improvements were observed for both cohorts in emotional functioning scale at certain study time points (TTF1 high: up to 9.1±25.7, TTF1 low: up to 6.6±17.0). A relatively high mean score was observed for cognitive function scale for both cohorts at baseline (TTF1 high: 70.1±30.2; TTF1 low: 72.5±21.4). Pts in the TTF1 low vs. high cohort showed more pronounced worsening of cognitive function. Median TDD was numerically longer (about one month) for TTF1 high (5,3 mo) compared to TTF1 low cohort (3,9 mo). The probability to maintain QoL after six months was similar between the two cohorts. Conclusions: QoL showed similar global and HR-QoL scores with only slight changes during the study. Median TDD was numerically longer for high TTF1 pts, but similar after six months between pts still on 2 nd line Nal/IRI/5-FU regardless of duration of TTF in 1 st -line. Clinical trial information: NCT03468335 .

This study investigates the prognosis of acute decompensated heart failure (ADHF) on admission (i.e., primary ADHF) as compared to ADHF onset during course of hospitalization (i.e., secondary ADHF) in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). Limited data regarding the prognostic impact of the timing of onset of ADHF is available. Consecutive patients with HFmrEF and ADHF were retrospectively included at one institution from 2016 to 2022. Patients with primary ADHF were compared to patients with secondary ADHF with regard to the primary endpoint all-cause mortality at 30 months. Kaplan–Meier, uni- and multivariable Cox proportional regression analyses were applied for statistics. From a total of 484 patients hospitalized with HFmrEF and ADHF, 67.98% (n = 329) were admitted with primary ADHF. Patients with secondary ADHF had higher rates of concomitant acute myocardial infarction, alongside with a higher extend of coronary artery disease. The risk of all-cause mortality at 30 months was not affected by the timing of ADHF (hazard ratio (HR) = 0.853; 95% confidence interval (CI) 0.653–1.115; p = 0.246). However, patients with primary ADHF were associated with a higher risk of HF-related rehospitalization at 30 months (HR = 2.513; 95% CI 1.555–4.065; p = 0.001), which was still evident after multivariable adjustment (HR = 2.347; 95% CI 1.418–3.883; p = 0.001). The timing of onset of ADHF was not associated with long-term mortality in HFmrEF, however primary ADHF was associated with a higher risk of HF-related rehospitalization.

Background/Objectives: The autologous reconstruction of the female breast using a microsurgical DIEP flap is a reliable and safe method. To detect impairments early and preserve the microvascular flap through timely revision, a better understanding of physiologic perfusion dynamics is necessary. This exploratory study examines changes in microcirculation in free DIEP flaps within the first 72 h after vascular anastomosis using laser Doppler flowmetry and white-light spectrophotometry. Methods: This single-center study analyzed retro- and prospectively collected data from female patients who underwent uneventful breast reconstruction using a DIEP flap and were monitored using the O2C device (LEA Medizintechnik, Giessen, Germany). Microcirculation was monitored continuously postoperatively for a period of 72 h. Results: A total of 36 patients with a mean age of 48.86 (9.36) years and a mean BMI of 26.78 (4.12) kg/m² received 40 DIEP flaps (four bilateral reconstructions). Microcirculatory blood flow showed a continuous increase, reaching up to 15% above its initial value within the first 72 h following anastomosis. The average tissue oxygen saturation (sO2) and relative hemoglobin (rHB) levels remained fairly stable throughout the study period, with overall reductions of 5.46% and 5.30%, respectively. Conclusions: Autologous breast reconstruction using a microvascular DIEP flap is a safe and reliable technique. This study showed an increase in blood flow over the 72 h study period. At the same time, sO2 and rHb showed stable levels. Deviations in these values could be interpreted as indicators of a perfusion disorder of the microvascular flap.

Background and Objectives: Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are rare yet life-threatening dermatologic conditions characterized by severe skin and mucous membrane involvement. Accurate prognostic systems are crucial for clinical management to assess disease severity and predict outcomes. The primary objective of this study was to assess the epidemiological characteristics and clinical outcomes of patients with Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap over a 17-year period at a specialized burn center. The secondary objectives were to evaluate the performance of existing prognostic scoring systems (SCORTEN, Re-SCORTEN, and ABCD-10) in predicting mortality and to propose a novel classification tree model to improve mortality prediction. Materials and Methods: A 17-year retrospective study at a burn center included 68 patients with SJS, SJS/TEN overlap, or TEN. Demographic, clinical, laboratory data, and prognostic scores (SCORTEN, Re-SCORTEN, ABCD-10) were collected and analyzed for associations with mortality. A classification tree was created to detect unknown determinants of SJS/TEN mortality. Results: The drug most frequently associated with the occurrence of SJS/TEN was metamizole. The mortality rate was 51%. Affected body surface area, platelet count, and serum blood urea nitrogen differed significantly between survivors and non-survivors. Regarding the scoring systems, only the Re-SCORTEN showed reliable differentiation for these groups. A classification tree model achieved an accuracy of 89% in predicting the mortality risk. In the ROC curve analysis, the AUC values were 0.88 for the classification tree, 0.66 for Re-SCORTEN, 0.61 for SCORTEN, and 0.56 for ABCD-10. Conclusions: This study explores mortality predictors in SJS/TEN via a classification tree model, highlighting potential factors for further investigation. While cautioning against immediate clinical application due to data constraints, the findings underscore the need for larger studies to validate and refine prediction models in this context.

Background: The study investigates sex-related differences and outcomes in unselected patients undergoing invasive coronary angiography (CA). Sex-based differences with regard to baseline characteristics and management of patients with cardiovascular disease have yet been demonstrated. However, their impact on long-term outcomes in unselected patients undergoing CA remains unknown. Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were included at one institution. Prognosis of male and female patients undergoing CA was investigated with regard to the primary endpoint of rehospitalization for heart failure (HF) at 36 months. Secondary endpoints comprised the risk of acute myocardial infarction (AMI) and coronary revascularization at 36 months, as well as in-hospital all-cause mortality. Statistical analyses included Kaplan–Meier analyses, as well as uni- and multivariable Cox proportional regression analyses. Results: From 2016 to 2022, 7691 patients undergoing CA were included (males: 65.1%; females: 34.9%). Males had a higher prevalence of coronary artery disease (CAD) (76.2% vs. 57.4%; p = 0.001), alongside a higher prevalence of 3-vessel CAD compared to females (33.9% vs. 20.3%; p = 0.001). The risk of rehospitalization for HF at 36 months was higher in males compared to females (22.4% vs. 20.3%; p = 0.036; HR = 1.127; 95% CI: 1.014–1.254; p = 0.027), which was no longer observed after multivariable adjustment. Male sex was associated with a higher risk of coronary revascularization (9.6% vs. 5.9%; p = 0.001; HR = 1.659; 95% CI: 1.379–1.997; p = 0.001), which was still evident after multivariable adjustment (HR = 1.650; 95% CI 1.341–2.029; p = 0.001). However, neither the risk of AMI at 36 months (8.1% vs. 6.9%; p = 0.077), nor the risk of in-hospital all-cause mortality (6.9% vs. 6.5%; p = 0.689) differed significantly between the two sexes. Conclusions: In consecutive patients undergoing coronary angiography, male sex was independently associated with an increased risk of coronary revascularization, but not HF-related rehospitalization.

Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.

Background Inflatable penile prosthesis (IPP) insertion is recommended for the treatment of patients with Peyronie’s disease (PD) and significant erectile dysfunction (ED); adjunctive procedures can be used for residual curvature after IPP placement. Aim To assess the management of penile curvature correction in PD patients undergoing IPP procedures within a large multinational, multicenter cohort. Methods A retrospective analysis was conducted on PD patients treated with IPP by 11 experienced prosthetic surgeons. Demographic, intraoperative, and postoperative data were analyzed to assess the improvement in penile curvature following IPP, including adjunctive correction techniques such as manual modeling, tunica albuginea plication, and grafting. Outcomes Curvature correction achieved after IPP placement and adjunctive procedures. Results For 499 PD patients treated with IPP, median age was 62.0 [30.0, 91.0] years with mean follow-up of 16.5 (SD = 12.9) months. The mean preoperative curvature was 39.4° (SD = 17.8°), with dorsal curvature being most common. Among our cohort, 17.6% had IPP-only placement, while the majority of 82.4% patients underwent IPP along with adjunctive correction procedures. Specifically, manual modeling (with/without the “scratch” technique) was used in 74.7% of cases, tunica albuginea plication in 4.8%, grafting in 2%, and combined grafting and modeling in 0.8%. Patients who underwent grafting generally had fewer preoperative comorbidities and more severe preoperative curvatures of 60.0° [45.0°, 70.0°]. Grafting also provided the highest median curvature correction of 55.0° [48.8°, 73.8°], (P < .001). Plication achieved a median curvature correction of 40.0° [28.8°, 41.2°], whereas modeling resulted in a median curvature reduction of 26.0° [20.0°, 39.5°], (P < .001). Clinical Implications We observed that grafting, though less frequently used, provided more curvature correction in severe PD cases undergoing IPP. Strengths and Limitations Large cohort size and multinational participation are strengths, though retrospective design and general variability in surgical techniques are limitations. Conclusion Adjunctive techniques, including grafting, plication, and modeling provide options for tailoring curvature correction to disease severity and patient characteristics. Future prospective studies are needed to standardize and evaluate the comparative outcomes of these techniques.

Background/Objectives: The perioperative interplay between blood pressure, vasopressors, and macrocirculation is well established. However, in the context of free flap surgery, the potential impact of these factors on microvascular flow remains elusive. The aim was to evaluate the impact of norepinephrine administration on the microcirculation of free flaps. Methods: Postoperative systolic blood pressure (sBP), norepinephrine infusion rates (NIRs), and free flap microcirculation were monitored prospectively and analyzed retrospectively in patients receiving free flap surgery who required postoperative intermediate (IMC) or intensive care (ICU). Blood flow, hemoglobin oxygenation (SO2), and relative hemoglobin levels (rHbs) were measured over a period of 24 hours post-anastomosis by laser-doppler flowmetry and white light spectroscopy using the “Oxygen to See” device (O2C, LEA Medizintechnik, Gießen, Germany). Multivariate analysis was performed to determine the impact of NIR on microvascular flow, adjusting for several confounding factors. Subgroup analysis was conducted by categorizing into three groups based on patients’ postoperative sBP. Results: Flaps were performed in 105 patients with a mean age of 61.46 ± 16.29 years. Postoperatively, an increase in microvascular flow over time was observed across all free flaps, while NIR decreased and sBP maintained stable values. Multivariate analysis revealed that the time post-anastomosis (B = 3.76, p < 0.001), SO2 (B = 0.55, p < 0.001), rHb (B= −0.79, p < 0.001), female gender (B = 29.25, p = 0.02), and no previous radiation therapy (B = 41.21, p = 0.04) had a significant impact on postoperative microvascular flow in free flaps. NIR, sBP, smoking status, old age, and ASA score showed no significant impact on free flap flow. Further, NIR showed no significant impact on microvascular flow in any of the subgroups investigated. Conclusions: These findings support the safety of using norepinephrine for maintaining stable blood pressure without compromising microvascular flow, offering valuable guidance for postoperative management.