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Vascularized tissue transfer in head and neck surgery: Is intensive care unit–based management necessary?
Author(s) -
Panwar Aru,
Smith Russell,
Lydiatt Daniel,
Lindau Robert,
Wieland Aaron,
Richards Alan,
Shostrom Valerie,
Militsakh Oleg,
Lydiatt William
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25608
Subject(s) - medicine , interquartile range , intensive care unit , head and neck , retrospective cohort study , emergency medicine , intensive care , surgery , intensive care medicine
Objectives/Hypothesis To study the impact of a non–intensive care unit (ICU)–based postoperative management strategy on patient outcomes following vascularized free tissue transfer for head and neck surgical defects. Study Design Retrospective cohort study. Methods The patients consisted of two groups of adults who underwent vascularized free tissue transfer for head and neck reconstruction between July 2007 and June 2012, at an academic and a community‐based hospital. By protocol, the first group of patients had a planned admission to the intensive care unit. After creation of a designated head and neck surgical unit, the second group was cared for in a protocol driven, non‐ICU setting. Outcomes and costs were compared between the two patient groups. Results There was no adverse impact on flap survival, inpatient morbidity, or mortality with the implementation of postoperative care outside of an ICU. The patients who stayed in the ICU in the immediate postoperative period had a longer median length of hospital stay (ICU vs. non‐ICU, 8 days [interquartile range {IQR} = 7–11 days] vs. 7 days [IQR = 6–9.5 days], P = .001). Median hospital charges and cost of care for patients who received ICU‐based care (US$109,367 [IQR = US$88,112–US$130,833] and US$33,642 [IQR = US$28,143–US$43,196], respectively) were significantly higher than those for non‐ICU–based care (US$86,195 [IQR = US$71,208–US$101,199] and US$28,524 [IQR = US$22,611–US$33,226], P < .0001). Conclusions We demonstrate that care in a non–intensive care setting following vascularized free tissue transfer is safe, less costly, and decreases length of hospital stay compared to routine intensive care–based management. Level of Evidence 2c. Laryngoscope , 126:73–79, 2016