No reduction in complication rate by stay in the intensive care unit for patients undergoing surgery for head and neck cancer and microvascular reconstruction

Abstract

Admission to an ICU did not reduce complications after microvascular reconstruction and, therefore, has only to be considered for selected cases.

Immediate postoperative extubation in patients undergoing free tissue transfer

“…We recognize that our difficulties with prompt extubation the morning following surgery may be center‐specific. However, the average ICU stay of 2.0 days and hospital stay of 8.2 days in the early extubation group are low relative to published data 1, 3, 4, 8, 10–15. This suggests that other centers may also benefit from instituting a policy of immediate extubation in appropriate patients.…”

“…As head and neck surgeons have become more comfortable and successful with the postoperative care of patients reconstructed with free flaps, greater attention is being given to the actual value of highly conservative approaches, such as prolonged postoperative intubation. There is evidence to show that the need for ICU admission in patients with FTT may be superfluous,4–7 and given that care in the ICU represents a large portion of the charges for inpatient care after FTT3 and puts patients at higher risk for certain complications such as nosocomial infections,9 bypassing the ICU altogether could improve cost‐effectiveness and patient safety. Given the observation at our institution that, on average, patients managed conservatively with prolonged postoperative intubation after FTT actually required mechanical ventilatory support for 12 hours longer than planned, we sought to evaluate the potential benefit and safety of immediate postoperative extubation.…”

“…However, there is no published evidence to support this practice. In fact, Nkenke et al recently demonstrated that in patients with oral or mandibular reconstruction with free flaps and good health status (no prior chemo‐ or radiotherapy, no advanced cardiovascular or pulmonary disease, and American Society of Anaesthesiologists physical status <III), there is no significant reduction in flap‐related, medical, or surgical complications when extubation is delayed 24 hours in the ICU compared to immediate postoperative extubation in the recovery room 4. However, there is no literature assessing the effect of immediate versus delayed extubation on ICU stay, hospital stay, and inpatient complications in all patients undergoing FTT regardless of health status.…”

Vascularized tissue transfer in head and neck surgery: Is intensive care unit–based management necessary?

“…Postoperative management strategies vary widely and differ between institutions and often individual practitioners . These differences are often related to physician training, personal experiences, and institutional factors such as access to resources and availability of trained personnel . Although there is some literature to suggest that patients undergoing major head and neck surgery can be safely cared for outside of an ICU, many physicians prefer to utilize the intensive care unit setting to monitor for flap compromise and airway issues .…”

Intraoral Microvascular Anastomosis for Segmental Mandibular Reconstruction Following Removal of an Ameloblastoma

“…40 Microvascular free bone transfer has become a very reliable procedure during the last few years. 41,42 Different donor sites are available for harvesting of microvascular grafts to reconstruct the continuity of the mandible. 43Y45 Often the fibula graft is the flap of choice.…”