Open AccessPostoperative care in an intermediate‐level medical unit after head and neck microvascular free flap reconstruction
Author(s) -
Yu Phoebe K.,
Sethi Rosh K.V.,
Rathi Vinay,
Puram Sidharth V.,
Lin Derrick T.,
Emerick Kevin S.,
Durand Marlene L.,
Deschler Daniel G.
Publication year - 2019
Publication title -
laryngoscope investigative otolaryngology
Language(s) - English
Resource type - Journals
ISSN - 2378-8038
DOI - 10.1002/lio2.221
Subject(s) - free flap , head and neck , medicine , free flap reconstruction , surgery , microvascular surgery , head (geology) , microsurgery , geomorphology , geology
Objective The need for intensive care unit (ICU) admission and mechanical ventilation after head and neck microvascular free flap reconstructive surgery remains controversial. Our institution has maintained a longstanding practice of immediately taking patients off mechanical ventilation with subsequent transfer to intermediate, non‐ICU level of care with specialized otolaryngologic nursing. Our objective was to describe postoperative outcomes for a large cohort of patients undergoing this protocol and to examine the need for routine ICU transfer. Materials and Methods We performed a retrospective review of 512 consecutive free flaps treated with a standard protocol of immediate postoperative transfer to an intermediate‐level care unit with specialized otolaryngology nursing. Outcome measures included ICU transfer, ventilator requirement, flap failure, postoperative complications, and length of stay. Predictors of ICU transfer were identified by multivariable logistic regression. Results The vast majority of patients did not require intensive care. Only a small fraction (n = 18 patients, 3.5%) subsequently transferred to the ICU, most commonly for respiratory distress, cardiac events, and infection. The most common complications were delirium/agitation (n = 55; 10.7%) and pneumonia (n = 51; 10.0%). Sixty‐five cases (12.7%) returned to the OR, most commonly for hematoma/bleeding (n = 41; 8.0%) and anastomosis revision (n = 20; 3.9%). Heavy alcohol consumption and greater number of medical comorbidities were significant predictors of subsequent ICU transfer. Conclusions Among head and neck free flap patients, routine cessation of mechanical ventilation and transfer to intermediate‐level care with specialized ENT nursing was found to be safe with infrequent subsequent ICU transfer and low complication rates. Routine transfer to intermediate‐level care in this population may prevent unnecessary ICU utilization and facilitate the delivery of high‐value, disease‐centered care. Level of Evidence 3b