Predictors of discharge destination after complex abdominal wall reconstruction

Factors Impacting Discharge Destination Following Head and Neck Microvascular Reconstruction

“…16,25,26 Additionally, as patient age increases there is an increased likelihood of having a dependent functional status, which also contributes to increased postoperative care needs. 10 A study by Fagin et al, which included patients greater than 90 years old who underwent head and neck reconstruction with a free flap, demonstrated that free flap patients with advanced age were more likely to require discharge to a nursing facility due to impaired functional outcomes; however, most patients eventually returned to their baseline functional status. 19 This data suggests that while functional capacity is reduced during the initial postoperative period, patients are able to return to their baseline function even in the setting of advanced age.…”

“…However, previous orthopedic, spine and general surgery publications have found patients of the female gender are more likely to be discharged to a facility. 9,10,13 Likewise, a study by Freeman et al, which reviewed patients undergoing head and neck ablation and free flap reconstruction, demonstrated female patients were more likely to require discharge to a facility. 15 While no clear association between gender and discharge destination is known, prior literature has shown that patients with poor social support were more likely to be discharged to a facility.…”

“…Current tobacco users had a higher incidence of wound dehiscence (9% [95% CI [6][7][8][9][10][11][12], n = 38/440) compared to non-smokers (6% [95% CI [5][6][7], n = 86/1452; p = 0.04). Patients with the underlying pulmonary disease also had a higher incidence of wound dehiscence (8% [95% CI 6-10], n = 54/673 vs. 6% [95% CI [5][6][7], n = 70/1,219; p = 0.04).…”

“…Patients with the underlying pulmonary disease also had a higher incidence of wound dehiscence (8% [95% CI 6-10], n = 54/673 vs. 6% [95% CI [5][6][7], n = 70/1,219; p = 0.04). Preoperative alcohol use was found to correlate with a higher incidence of wound infections (12% [95% CI [10][11][12][13][14], n = 106/882) compared to non-alcohol users (8% [95% CI 7-10], n = 85/1010; p = 0.01).…”

“…[3][4][5][6][7][8] Prior studies in the neurosurgery, vascular, and general surgery literature have demonstrated advanced age, gender, frailty, and underlying medical conditions contribute to discharge to a facility postoperatively. 5,[8][9][10][11][12][13][14] Similarly, literature in head and neck free flap reconstruction demonstrated that advanced age and functional status influence discharge destination. [15][16][17][18][19][20] However, the complexity of the reconstruction, including donor site selection, and the specifics of the surgical and medical complications were not included in these prior publications.…”