Vascularized tissue transfer in head and neck surgery: Is intensive care unit-based management necessary?

Abstract

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.

Keywords: Head and neck; cost; free flap; intensive care unit; length of stay; microvascular reconstruction; outcomes; postoperative care; vascularized tissue transfer.