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. 2021 Jun;131(6):E1821-E1829.
doi: 10.1002/lary.29382. Epub 2021 Jan 13.

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

Mary Han  1   2 , Edgar Ochoa  1   2 , Bovey Zhu  2 , Andrea M Park  2 , Chase M Heaton  2 , Rahul Seth  2 , P Daniel Knott  2
Affiliations

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

Mary Han et al. Laryngoscope. 2021 Jun.

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.

Level of evidence: 4 Laryngoscope, 131:E1821-E1829, 2021.

Keywords: Free flap surgery; cost analysis; head and neck; reconstructive surgery; take-back.

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References

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