Length of Stay After Free Flap Reconstruction of the Head and Neck

Abstract

OfVectives: To analyze the incidence and timing of postoperative complications after free tissue transfer (FIT) and relate that to length of stay (LOS.) Study Design; We reviewed on surgeon's experience with 97 pa tients undergoing 100 head and neck reconstructions via FIT for a variety of traumatic and ablative defects. Methods: Charts were reviewed for d emographic data, type of d efect and flap, complications, LOS, length of intensive care unit (ICU) stay, date of decannulation, and first oral intake, any readmission to the hospital, and preoperative radiation status. llesults: Using strict guid lin s, 31 o of patien ts had some form of complication, including a 9o/o flap failure rate. Average postoperative LOS for all patients was 11 days. Average LOS for uncomplicated cases was 9 and for complicated cases was 16 days. For cases with flap-related complications th av rage LOS rose to 20 days. All reconstructive failures (d fined as patients requiring subsequent surgical procedures after a flap-related complication, regardless of outcome) occurred within the first 7 postoperative days. Three patients were readmitted for various rean s: a partial flap dehisc n ee (postoperative day [POD] 9), m eningitis (POD 24), and orocutaneous fistula (POD 22), for a 3.2% readmission rate. Fourteen percent of pa ti n ts were on a regimen of oral intake, and 13% had d cannulation by the time of discharge. Resumption of oral intalce and tracheostomy decannulation were accomplish d on a n outpatient b asis in the remainder of p atient • Conclusions: There were no preventable compUcations associated with early hospital discharge, nor was there evidence of adverse patient outcome. We conclude that early hospital disch arge is feasible after FIT reconstnaction and is consistent with quality care. Key Words: Free tissu transfer, head and n eck reconstruction, length of stay.Lary11goscope , 110:210-216, 2000 Present d at the Meeting of the Southern Section of the Am rican Laryngologicn l, Rhin ologico l a nd Otologica l Society, Inc., New Orleans, Loui siana, J a nu ary 15, 1.999.From the D partment of Otolaryngology a nd omm unicetive Scinces (M.W.R., M.11 .), Th M dical University of South arolina, and The Facial Surg ry enter (M .11. ), ha rleston, South a rolina; end the Departrn nt ofO tolaryngology (M.W.R.),

Management of Post-Operative Maxillofacial Oncology Patients Without the Routine Use of an Intensive Care Unit

“…Some centers admit all patients to an ICU after head and neck procedures [4]. Ryan and Hochman [16] could not find complications associated with early hospital discharge. Inversely to the expected, staying in an ICU for at least 3 days was encouraged for better monitoring of the patient's condition.…”

Comorbid condition as a prognostic factor for complications in major surgery of the oral cavity and oropharynx with microvascular soft tissue reconstruction

“…Others, who used different classifications, report a major complication rate of 15% to 23%. 10,28 Postoperative complication rates among different studies are somewhat difficult to compare. An ideal and universally accepted postoperative scoring system for complications in surgical treatment of head and neck cancer patients does not exist.…”

“…Whereas some authors use broad categories of clinically important complications, others use a much more detailed scoring system that includes every minor deviation from the normal course. 10,28,29 Such minor complications can probably be omitted, because no relation with comorbid ailments has ever been shown.…”

Evaluating risk factors and predicting complications in head and neck reconstructive surgery

“…Major complications occurring in patients with head and neck cancer undergoing reconstructive surgery are reported to range between 15 and 30% [1][2][3]. Articles addressing this issue have focused on a host of variables such as patient age, tobacco use, prior irradiation, operative time, transfusion, fluid administration, diabetes, coronary artery disease, hypertension, alcohol use, lung disease, cerebrovascular disease, and body mass index to predict complications using different statistical methods.…”

“…The effects of radiation on arteries and veins have been clearly established, including endothelial damage and perivascular fibrosis, which diminish the quality of anastomotic targets in the irradiated field. Although many cases requiring free tissue reconstruction have been subject to prior irradiation, the body of literature has been unable to agree upon the significance of prior radiation relative to wound complications, medical complications, or increased hospital stay [1,3,6,17,18]. The lack of agreement in the literature is most likely because of overall low flap failure rates and resultant dearth of statistical power in the studies to date.…”