Cost and clinical outcomes of postoperative intensive care unit versus general floor management in head and neck free flap reconstructive surgery patients

Aponte-Ortiz, Jaime A.; Greenberg, Alexandra J.; Marinelli, John P.; May, Matthew; Spears, Grant M.; Labott, Joshua R.; Mecham, Jeffrey C.; Moore, Eric J.; Visscher, Sue L.; Borah, Bijan J.; Janus, Jeffrey R.

doi:10.1016/j.amjoto.2021.103029

Cited by 3 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study is limited by the retrospective nature at a single tertiary institution. The lack of direct cost data for each patient's entire hospitalization makes generalizations regarding cost savings difficult to elucidate, as our analysis does not account for re‐operation or costs independently associated with complications or consultations, although this has been described in other papers 17,18,23 …”

Section: Discussionmentioning

confidence: 99%

Comparative Outcomes for Microvascular Free Flap Monitoring Outside the Intensive Care Unit

Stevens,

Prasad,

Sharma

et al. 2024

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

ObjectiveThere is a trend towards nonintensive care unit (ICU) or specialty ward management of select patients. Here, we examine postoperative outcomes for patients transferred to a general ward following microvascular free flap (FF) reconstruction of the head and neck.Study DesignRetrospective quality control study.SettingSingle tertiary care center.MethodsConsecutive patients who underwent FF of the head and neck before and after a change in protocol from immediate postoperative monitoring in the ICU (“Pre‐protocol”) to the general ward setting (“Post‐protocol”). Outcomes included overall length of stay (LOS), ICU LOS, FF compromise, and postoperative complications.ResultsA total of 150 patients were included, 70 in the pre‐protocol group and 80 in the post‐protocol group. There were no significant differences in age, sex, comorbidities, tumor stage, or type of FF. Mean LOS decreased from 8.18 to 7.68 days (P = .4), and mean ICU LOS decreased significantly from 5.2 to 1.7 days (P < .01). There were no significant differences in postoperative or airway‐related complications (P = .6) or FF failure rate (2.9% vs 2.6%, P > .9). There was a non‐significant increase in ancillary consults in the post‐protocol group (45% vs 33%, P = .13) and a significant increase in rapid response team calls, a nurse‐driven safety net for abnormal vitals or mental status (19% vs 3%, P = .003).ConclusionWe show the successful implementation of a protocol shifting care of FF patients from the ICU to a general ward postoperatively, suggesting management on the floor with less frequent flap monitoring is safe and conserves ICU beds. Additional teaching and familiarity with these patients may over time reduce the rapid response calls.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparative Outcomes for Microvascular Free Flap Monitoring Outside the Intensive Care Unit

Stevens,

Prasad,

Sharma

et al. 2024

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…Traditionally, postoperative ICU care has been the standard of care for free flap patients, seemingly due to the need for frequent flap monitoring. In recent years, this presumption has been challenged with studies showing comparable free flap outcomes in head and neck cancer patients managed on specialty floors instead of the ICU (Aponte‐Ortiz et al, 2021; Arshad et al, 2014; Panwar et al, 2016; Strauss & Bellian, 1999). At the onset of the COVID‐19 pandemic, we shifted our practice to admit free flap patients to the floor.…”

Section: Introductionmentioning

confidence: 99%

Intensive care unit versus floor admission following lower extremity free flap surgery: Is there a difference in outcomes?

et al. 2022

View full text Add to dashboard Cite

Background: Free tissue transfer (FTT) lower limb salvage requires costly multidisciplinary care. Traditionally, patients who undergo FTT reconstruction for lower extremity (LE) wounds were admitted to the intensive care unit (ICU) in the immediate postoperative period for close monitoring. During the COVID-19 pandemic, our practice shifted toward admitting FTT patients to the floor postoperatively instead of the ICU. The purpose of this study is to compare surgical outcomes in patients admitted to the floor versus ICU immediately following LE free flap reconstruction. Methods: We retrospectively reviewed patients undergoing LE FTT reconstruction from 2011 to 2021. Flap monitoring consisted of an implantable Cook-Swartz Doppler probe for muscle flaps and ViOptix tissue oximetry for fasciocutaneous flaps; clinical exam and hand-held dopplers were not the primary flap monitoring techniques. Patients were divided into two groups depending on whether they went to the ICU or floor postoperatively. To ensure proper comparability between cohorts, we corrected for age, BMI and Charlson Comorbidity Index (CCI) using 1:2 propensity score matching (floor: ICU). Primary outcomes included early postoperative complications, flap takeback and salvage, flap success, and postoperative length of stay (LOS).Results: A total of 252 patients were identified. Forty-five patients (17.9%) were admitted to the floor postoperatively and 207 patients (82.1%) to the ICU. Overall, microsurgical success rate was 97.2%, which was similar for floor and ICU patients.Flap takeback and salvage were similar between cohorts. Average postoperative LOS was significantly shorter in floor patients (15.7 vs. 19.1 days, p = 0.043). Conclusion:Our findings suggest that postoperative floor admission does not decrease flap success rates and should be considered in patients who undergo FTT to LE reconstruction and are otherwise stable. In the ongoing era of health care cost containment, microsurgery centers should consider appropriate floor training to allow medically stable free flap patients to avoid an ICU stay. | INTRODUCTIONMicrovascular free tissue transfer (FTT) is a reliable surgical option to reconstruct complex lower extremity (LE) wound defects, with flap success rates approaching 99% (Bigdeli et al., 2019;Khouri et al., 1998;Xiong et al., 2016). Postoperative management patterns differ between institutions, and no one protocol has been proven superior (Rohde et al., 2009). Nevertheless, many patients who

show abstract

Admission patterns and outcomes of postoperative oral cavity and oropharyngeal cancer patients admitted to critical care in the UK: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database

McGoldrick

Edwards

Abdelrahman

et al. 2022

British Journal of Oral and Maxillofacial Surgery

View full text Add to dashboard Cite

Cost and clinical outcomes of postoperative intensive care unit versus general floor management in head and neck free flap reconstructive surgery patients

Cited by 3 publications

References 20 publications

Comparative Outcomes for Microvascular Free Flap Monitoring Outside the Intensive Care Unit

Comparative Outcomes for Microvascular Free Flap Monitoring Outside the Intensive Care Unit

Intensive care unit versus floor admission following lower extremity free flap surgery: Is there a difference in outcomes?

Admission patterns and outcomes of postoperative oral cavity and oropharyngeal cancer patients admitted to critical care in the UK: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database

Contact Info

Product

Resources

About