Delayed mobilization after microsurgical reconstruction: An independent risk factor for pneumonia

Yeung, Justin K.; Harrop, Robertson; McCreary, Olivia; Leung, Leslie Tze Fung; Hirani, Naushad; McKenzie, D. C.; Haas, Vim de; Matthews, T. Wayne; Nakoneshny, Steve; Dort, Joseph C.; Schrag, Christiaan

doi:10.1002/lary.24241

Cited by 48 publications

(44 citation statements)

References 18 publications

(50 reference statements)

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“…Care pathways may have a beneficial postdischarge impact for a number of reasons. First, patients treated on a care pathway tend to have shorter hospitalizations and fewer complications . This could then result in a less complicated postdischarge course and, therefore, less postdischarge resource utilization.…”

Section: Discussionmentioning

confidence: 99%

“…Pathway patients who deviated from the pathway were included in all analyses. The details of the inpatient care pathway have been previously published …”

Section: Methodsmentioning

confidence: 99%

“…The details of the inpatient care pathway have been previously published. 10,11 Collection and analysis of healthcare utilization and costs…”

Section: Study Cohortmentioning

confidence: 99%

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Understanding the impact of a clinical care pathway for major head and neck cancer resection on postdischarge healthcare utilization

et al. 2015

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Section: Discussionmentioning

confidence: 99%

“…Pathway patients who deviated from the pathway were included in all analyses. The details of the inpatient care pathway have been previously published …”

Section: Methodsmentioning

confidence: 99%

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Understanding the impact of a clinical care pathway for major head and neck cancer resection on postdischarge healthcare utilization

et al. 2015

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“…The timing of mobilization is clearly important, because early mobilization has been shown to be better than late mobilization. 119,121 However, the impact of "dose" of mobilization has not been studied. Data on the number of minutes per day of patient activity have been inconsistently reported across studies.…”

Section: Postoperative Mobilizationmentioning

confidence: 99%

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

Dort

Farwell

Findlay

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. Findings: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. Conclusions and Relevance: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.

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“…16 It is conceivable that fluid overload could lead to exacerbated congestive heart failure (CHF), pulmonary edema, and respiratory failure. We had originally hypothesized that cardiopulmonary complications were to blame, as pulmonary complications are common in head and neck microvascular surgery, with incidences reported as high as 67.7%.…”

Section: Medical Complicationsmentioning

confidence: 99%

Intraoperative and postanesthesia care unit fluid administration as risk factors for postoperative complications in patients with head and neck cancer undergoing free tissue transfer

et al. 2019

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Background: This study aims to evaluate the impact of perioperative fluid administration, defined as fluid delivered intraoperatively and in the postanesthesia care unit, on postoperative outcomes. Methods: Medical records of 102 patients with oral cavity squamous cell carcinoma undergoing free flap reconstruction between January 2011 and December 2015 were reviewed. The primary endpoint was development of a postoperative complication according to the Clavien-Dindo classification. Perioperative factors recorded were Washington University Head and Neck Comorbidity Index, operating time, vasopressor use, blood loss, intraoperative fluid, and perioperative fluid. Results: Greater perioperative fluid administration was independently associated with surgical complications, flap complications, overall incidence of any complication, and increased length of stay. Greater intraoperative fluid administration was independently associated with higher rates of surgical complications. Intraoperative delivery of vasopressors was not associated with flap or surgical complications. Conclusion: Receiving less perioperative fluid was associated with fewer complications and decreased length of stay. K E Y W O R D S free tissue transfer, head and neck cancer, intraoperative fluid, oral cavity squamous cell carcinoma, perioperative fluid, postanesthesia care unit, postoperative complication

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Delayed mobilization after microsurgical reconstruction: An independent risk factor for pneumonia

Abstract: Late mobilization of free flap patients is an independent risk factor for developing postoperative pneumonia. Earlier mobilization does not increase flap failure rates, is safe, and should be strongly considered in all free flap patients to reduce pulmonary complications.

Cited by 48 publications

References 18 publications

Understanding the impact of a clinical care pathway for major head and neck cancer resection on postdischarge healthcare utilization

Understanding the impact of a clinical care pathway for major head and neck cancer resection on postdischarge healthcare utilization

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

Intraoperative and postanesthesia care unit fluid administration as risk factors for postoperative complications in patients with head and neck cancer undergoing free tissue transfer

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