Risk Factors for and Cost Implications of Free Flap Take‐backs: A Single Institution Review

Abstract

Objective/Hypothesis: For patients undergoing microvascular free tissue transfer (MFTT), we evaluated risk factors and financial implications of operating room (OR) take-back procedures.Study Design: Retrospective review at a tertiary care center. Methods: Patients who underwent MFTT for head and neck reconstruction from 2011 to 2018 were identified. We compared hospital length of stay and overall costs associated with OR take-back procedures. Multivariable regression analysis evaluated factors associated with OR take-backs during the same hospitalization.Results: A total of 727 free flaps were reviewed, and 70 OR take-backs (9.6%) were identified. Mean total length of stay (LOS) in the ICU was 3.4 days versus 6.7 days for non-take-back and take-back flaps, respectively (P < .001). Mean total LOS on the regular floor was 6.3 days versus 13.1 days, respectively (P < .001). This resulted in a cost differential of $33,507 (94.3% increase relative to non-take-back flaps). The total cost associated with an OR take-back was $39,786. Hematomas were the most common cause of take-backs and wound dehiscence was associated with the highest costs. On multivariable analysis, higher ASA class (OR, 2.06; 95% CI, 1.11-3.99; P = .026) and shorter ischemia times (OR, 0.52; 95% CI, 0.29-0.95; P = .030) were independently associated with increased risk of take-backs.Conclusions: OR take-backs infrequently occur but are associated with a significant increase in financial burden when compared to free flap cases not requiring OR take-back. The large majority of the cost differential lies in a substantial increase of ICU and floor LOS for take-back flaps when compared to non-take-back flaps.

Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer

“…This finding is most apparent and substantial in the short-term postoperative period, but aesthetic outcomes beyond 1 year from surgery are not well known. In previous studies, patients undergoing heterogeneous reconstructive approaches, ranging from primary closure to microvascular free tissue transfer (MFTT), have been analyzed together . Microvascular free tissue transfer—the most complicated choice in a graduated system of reconstruction designed to meet the complexity of the surgical wound—is usually reserved for the most-advanced cancers and most serious defects .…”

“…In previous studies, patients undergoing heterogeneous reconstructive approaches, ranging from primary closure to microvascular free tissue transfer (MFTT), have been analyzed together. [15][16][17][18] Microvascular free tissue transfer-the most complicated choice in a graduated system of reconstruction designed to meet the complexity of the surgical wound-is usually reserved for the most-advanced cancers and most serious defects. 15,16 Microvascular free tissue transfer also has substantial complication rates that may require hospital readmission and/or operating room takebacks.…”

“…15,16 Microvascular free tissue transfer also has substantial complication rates that may require hospital readmission and/or operating room takebacks. 17,18 As a result, patients with HNC undergoing MFTT are likely at the greatest risk for impaired aesthetic outcomes and psychosocial functioning.…”

Effect of microporous polysaccharide hemospheres on anterolateral thigh free flap donor site complications

“…As a result, the ALT free tissue donor site is highly versatile and permits reconstruction of a wide variety of defects requiring skin coverage, soft tissue volume, internal nasal lining, bone, and cutaneous defects, or even vascularized facial nerve reconstruction 4–9 . Complications are uncommon, but may result in extended hospital stay, additional surgical interventions, and increased cost to the healthcare system 10 . Seroma is the most common donor site complication and may occur in ~5%–6% of cases 11,12 .…”

“…[4][5][6][7][8][9] Complications are uncommon, but may result in extended hospital stay, additional surgical interventions, and increased cost to the healthcare system. 10 Seroma is the most common donor site complication and may occur in $5%-6% of cases. 11,12 Unfortunately, this risk persists despite the use of surgical drains and there is a paucity of literature describing reliable interventions to prevent seroma formation.…”