TY - JOUR
T1 - Vascularized tissue transfer in head and neck surgery
T2 - Is intensive care unit-based management necessary?
AU - Panwar, Aru
AU - Smith, Russell
AU - Lydiatt, Daniel
AU - Lindau, Robert
AU - Wieland, Aaron
AU - Richards, Alan
AU - Shostrom, Valerie
AU - Militsakh, Oleg
AU - Lydiatt, William
N1 - Publisher Copyright:
© 2015 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Objectives/Hypothesis To study the impact of a non-intensive care unit (ICU)-based postoperative management strategy on patient outcomes following vascularized free tissue transfer for head and neck surgical defects. Study Design Retrospective cohort study. Methods The patients consisted of two groups of adults who underwent vascularized free tissue transfer for head and neck reconstruction between July 2007 and June 2012, at an academic and a community-based hospital. By protocol, the first group of patients had a planned admission to the intensive care unit. After creation of a designated head and neck surgical unit, the second group was cared for in a protocol driven, non-ICU setting. Outcomes and costs were compared between the two patient groups. Results There was no adverse impact on flap survival, inpatient morbidity, or mortality with the implementation of postoperative care outside of an ICU. The patients who stayed in the ICU in the immediate postoperative period had a longer median length of hospital stay (ICU vs. non-ICU, 8 days [interquartile range {IQR} = 7-11 days] vs. 7 days [IQR = 6-9.5 days], P =.001). Median hospital charges and cost of care for patients who received ICU-based care (US$109,367 [IQR = US$88,112-US$130,833] and US$33,642 [IQR = US$28,143-US$43,196], respectively) were significantly higher than those for non-ICU-based care (US$86,195 [IQR = US$71,208-US$101,199] and US$28,524 [IQR = US$22,611-US$33,226], P <.0001). Conclusions We demonstrate that care in a non-intensive care setting following vascularized free tissue transfer is safe, less costly, and decreases length of hospital stay compared to routine intensive care-based management.
AB - Objectives/Hypothesis To study the impact of a non-intensive care unit (ICU)-based postoperative management strategy on patient outcomes following vascularized free tissue transfer for head and neck surgical defects. Study Design Retrospective cohort study. Methods The patients consisted of two groups of adults who underwent vascularized free tissue transfer for head and neck reconstruction between July 2007 and June 2012, at an academic and a community-based hospital. By protocol, the first group of patients had a planned admission to the intensive care unit. After creation of a designated head and neck surgical unit, the second group was cared for in a protocol driven, non-ICU setting. Outcomes and costs were compared between the two patient groups. Results There was no adverse impact on flap survival, inpatient morbidity, or mortality with the implementation of postoperative care outside of an ICU. The patients who stayed in the ICU in the immediate postoperative period had a longer median length of hospital stay (ICU vs. non-ICU, 8 days [interquartile range {IQR} = 7-11 days] vs. 7 days [IQR = 6-9.5 days], P =.001). Median hospital charges and cost of care for patients who received ICU-based care (US$109,367 [IQR = US$88,112-US$130,833] and US$33,642 [IQR = US$28,143-US$43,196], respectively) were significantly higher than those for non-ICU-based care (US$86,195 [IQR = US$71,208-US$101,199] and US$28,524 [IQR = US$22,611-US$33,226], P <.0001). Conclusions We demonstrate that care in a non-intensive care setting following vascularized free tissue transfer is safe, less costly, and decreases length of hospital stay compared to routine intensive care-based management.
KW - Head and neck
KW - cost
KW - free flap
KW - intensive care unit
KW - length of stay
KW - microvascular reconstruction
KW - outcomes
KW - postoperative care
KW - vascularized tissue transfer
UR - http://www.scopus.com/inward/record.url?scp=84955176241&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84955176241&partnerID=8YFLogxK
U2 - 10.1002/lary.25608
DO - 10.1002/lary.25608
M3 - Article
C2 - 26343412
AN - SCOPUS:84955176241
SN - 0023-852X
VL - 126
SP - 73
EP - 79
JO - Laryngoscope
JF - Laryngoscope
IS - 1
ER -