Post‐acute care use after major head and neck oncologic surgery with microvascular reconstruction

Parhar, Harman S.; Chang, Brent A.; Durham, J.S.; Anderson, Donald W.; Hayden, Richard E.; Prisman, Eitan

doi:10.1002/lary.27190

Cited by 9 publications

(43 citation statements)

References 33 publications

(67 reference statements)

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“…No previous studies had reported on insurance status or family support in this population. Our finding that prolonged hospitalization was a risk factor was also shown by Parhar et al and Hatcher et al 11,13 While tracheostomy was revealed to be an independent risk factor in the current study, Cramer et al did not find a significant difference in the need for post–acute care in patients with tracheostomies at discharge. 10 Increasing age was also an independent risk factor for post–acute care in this population.…”

Section: Discussionsupporting

confidence: 84%

“…13 Patients in the aforementioned studies also had reconstruction of a wide variety of head and neck defects. 10,11,13 Thus, we sought to identify demographic, perioperative, and social factors that independently predict the need for post–acute care in a cohort of patients undergoing free tissue transfer to reconstruct defects involving the oral cavity. Identifying patients who may need post–acute care may help with earlier discharge planning to reduce hospital length of stay and in counseling the patient and family about likely postoperative care needs.…”

mentioning

confidence: 99%

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Risk Factors for Post–acute care Following Free Flap Reconstruction of the Oral Cavity

Lepse

Sykes

Kakarala

2020

Otolaryngol.--head neck surg.

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Objective Identify previously unreported factors that predict the need for post–acute care after free flap reconstruction of the oral cavity. Study Design Retrospective cohort study. Setting Single academic medical center. Methods A total of 134 patients with head and neck disease involving the oral cavity underwent free tissue transfer for reconstruction between August 2012 and October 2015. All patients had a tracheostomy placed at the time of surgery. Data were collected, including demographics, perioperative risk factors, and social variables. Univariate and multivariate logistic regression were used to identify risk factors for needing post–acute care. Results Of 134 patients, 37 (28%) required post–acute care upon discharge, and 97 of 134 (72%) were discharged home with assistance. Multivariate logistic regression revealed that lack of family support (adjusted odds ratio [AOR], 32.12; 95% CI, 13.75-274.90; P = .002), tracheostomy tube at discharge (AOR, 13.70; 95% CI, 3.20-58.44; P < .001), government insurance (AOR, 3.85; 95% CI, 1.13-13.11; P = .031), hospital stay >10 days (AOR, 3.52; 95% CI, 1.25-9.90; P = .017), and increasing age (AOR, 1.11; 95% CI, 1.04-1.18; P = .003) were significantly associated with post–acute care need. Conclusion: Lack of family support, tracheostomy tube at discharge, government insurance, hospital stay >10 days, and increasing age are independently associated with the need for post–acute care following free flap reconstruction of the oral cavity. Physicians, social workers, and nurse case managers are positioned to identify patients at high risk for needing post–acute care and to reduce the duration of hospitalizations.

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

Risk Factors for Post–acute care Following Free Flap Reconstruction of the Oral Cavity

Lepse

Sykes

Kakarala

2020

Otolaryngol.--head neck surg.

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“…5 Nearly one-third of our cohort were discharged to PACFs. This matches the rate previously reported for microvascular reconstruction after major head and neck surgery by Cramer et al 5 (33.6%) but is elevated compared to that of Parhar et al 6 (15.8%) and Hatcher et al 7 (14.2%). Cramer et al 5 and Parhar et al 6 analyzed the National Surgical Quality Improvement Program (NSQIP) database, which included nonacademic, nontertiary referral hospitals that may serve a healthier patient population.…”

Section: Discussionsupporting

confidence: 90%

“…2,3 Since 2012, PACFs have accounted for about $41 billion in annual Medicare fee-for-service expenditures. 4 Patients undergoing major head and neck surgery are large contributors to these costs, as 14% to 16% are discharged to PACFs 5-7 for continued occupational, physical, and speech-language therapies. 8-10 Some factors that contribute to this disposition include age, functionality, comorbidities, available social support in the home setting, length of hospital stay, postoperative complications, and frailty.…”

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confidence: 99%

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Skeletal Muscle Index’s Impact on Discharge Disposition After Head and Neck Cancer Free Flap Reconstruction

Jones

Campiti

Alwani

et al. 2020

Otolaryngol.--head neck surg.

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Objective To determine the role of skeletal muscle index (SMI) in the assessment of frailty and determination of discharge to post–acute care facilities (PACF) after head and neck cancer free flap reconstruction (HNCFFR). Study Design Retrospective cohort. Setting Single-institution, academic tertiary referral center. Methods Adult patients undergoing HNCFFR from 2014 to 2019 with preoperative abdominal computed tomography imaging were retrospectively analyzed. Patient demographics, 5-factor modified frailty index (5-mFI), body mass index (BMI), SMI at the third lumbar vertebra, oncologic history, perioperative data, and Clavien-Dindo (CD) complications were collected. Binary logistic regression was used to identify independent predictors of discharge disposition. Results The cohort consisted of 206 patients, 62 (30.1%) of whom were discharged to PACF. Patients discharged to PACF were of older age (65.4 vs 57.1 years, P < .0001) and had a lower SMI (38.8 vs 46.8 cm2/m2, P < .0001), higher 5-mFI (≥3; 25.8% vs 4.2%, P < .0001), and greater incidence of stage IV (80.6% vs 64.1%, P = .0211) aerodigestive cancer (80.6% vs 66.7%, P = .0462). Patients discharged to PACF experienced more blood transfusions (74.2% vs 35.4%, P < .0001), major postoperative complications (CD ≥3, 40.3% vs 12.9%, P < .0001), and delirium (33.9% vs 4.2%, P < .0001). After adjusting for pre- and postoperative factors, multivariate binary logistic regression identified age ( P = .0255), 5-mFI ( P < .0042), SMI ( P = .0199), stage IV cancer ( P = .0250), aerodigestive tumor ( P = .0366), delirium ( P < .0001), and perioperative blood transfusion ( P = .0144) as independent predictors of discharge to PACF. Conclusions SMI and 5-mFI are independently associated with discharge to PACF after HNCFFR and should be considered in preoperative planning and assessment of frailty.

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Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta‐analysis

Barlow,

Sragi,

Rodriguez

et al. 2024

Head & Neck

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BackgroundTraditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6–14 days post‐operatively due to concern for orocutaneous fistula development.MethodsMultiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed‐ and random‐effects meta‐analyses were used.ResultsOne randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = −0.02, p = 0.06) or free flap failure (RD = −0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = −2.43, p < 0.01).ConclusionsWhile further prospective trials are necessary, initiation of oral intake before post‐operative day 5 may be appropriate in properly selected patients following oral reconstruction.

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Post‐acute care use after major head and neck oncologic surgery with microvascular reconstruction

Abstract: Level 2c. Laryngoscope, 2532-2538, 2018.

Cited by 9 publications

References 33 publications

Risk Factors for Post–acute care Following Free Flap Reconstruction of the Oral Cavity

Risk Factors for Post–acute care Following Free Flap Reconstruction of the Oral Cavity

Skeletal Muscle Index’s Impact on Discharge Disposition After Head and Neck Cancer Free Flap Reconstruction

Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta‐analysis

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