Length of Stay After Free Flap Reconstruction of the Head and Neck

(1) Background: Surgical outcomes in free flap reconstruction of head and neck defects in cancer patients have improved steadily in recent years; however, correct anaesthesia management is also important. The aim of this study has been to show whether goal directed therapy can improve flap viability and morbidity and mortality in surgical patients. (2) Methods: we performed an observational case control study to analyse the impact of introducing a semi invasive device (Flo Trac®) during anaesthesia management to optimize fluid management. Patients were divided into two groups: one received goal directed therapy (GDT group) and the other conventional fluid management (CFM group). Our objective was to compare surgical outcomes, complications, fluid management, and length of stay between groups. (3) Results: We recruited 140 patients. There were no differences between groups in terms of demographic data. Statistically significant differences were observed in colloid infusion (GDT 53.1% vs. CFM 74.1%, p = 0.023) and also in intraoperative and postoperative infusion of crystalloids (CFM 5.72 (4.2, 6.98) vs. GDT 3.04 (2.29, 4.11), p < 0.001), which reached statistical significance. Vasopressor infusion in the operating room (CFM 25.5% vs. GDT 74.5%, p < 0.001) and during the first postoperative 24h (CFM 40.6% vs. GDT 75%, p > 0.001) also differed. Differences were also found in length of stay in the intensive care unit (hours: CFM 58.5 (40, 110) vs. GDT 40.5 (36, 64.5), p = 0.005) and in the hospital (days: CFM 15.5 (12, 26) vs. GDT 12 (10, 19), p = 0.009). We found differences in free flap necrosis rate (CMF 37.1% vs. GDT 13.6%, p = 0.003). One-year survival did not differ between groups (CFM 95.6% vs. GDT 86.8%, p = 0.08). (4) Conclusions: Goal directed therapy in oncological head and neck surgery improves outcomes in free flap reconstruction and also reduces length of stay in the hospital and intensive care unit, with their corresponding costs. It also appears to reduce morbidity, although these differences were not significant. Our results have shown that optimizing intraoperative fluid therapy improves postoperative morbidity and mortality.

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Predicting length of stay in head and neck patients who undergo free flap reconstruction

Laryngoscope Investigative Otolaryngology ◽

10.1002/lio2.410 ◽

2020 ◽

Vol 5 (3) ◽

pp. 461-467 ◽

Cited By ~ 1

Author(s):

Michael M. Lindeborg ◽

Rosh K. V. Sethi ◽

Sidharth V. Puram ◽

Anuraag Parikh ◽

Bharat Yarlagadda ◽

...

Keyword(s):

Length Of Stay ◽

Head And Neck ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction

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The impact of early oral feeding following head and neck free flap reconstruction on complications and length of stay

Oral Oncology ◽

10.1016/j.oraloncology.2020.105094 ◽

2021 ◽

Vol 113 ◽

pp. 105094

Author(s):

Cyrus J. Kerawala ◽

Francesco Riva ◽

Vinidh Paleri

Keyword(s):

Length Of Stay ◽

Head And Neck ◽

Free Flap ◽

Oral Feeding ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Early Oral Feeding ◽

The Impact

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Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction

Cancers ◽

10.3390/cancers13122852 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2852

Author(s):

Rosie Twomey ◽

T. Wayne Matthews ◽

Steven Nakoneshny ◽

Christiaan Schrag ◽

Shamir P. Chandarana ◽

...

Keyword(s):

Length Of Stay ◽

Head And Neck ◽

Free Flap ◽

Enhanced Recovery ◽

Early Mobilization ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Prolonged Length ◽

Major Complications ◽

The Impact

Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95% CI [confidence interval] = 1.16–2.57) and more major complications (OR = 1.76; 95% CI = 1.00–3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95% CI = 1.10–6.21) and prolonged length of stay (>10 days; OR = 2.85, 95% CI = 1.41–5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.

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Enhanced Recovery After Surgery–Based Perioperative Protocol for Head and Neck Free Flap Reconstruction

OTO Open ◽

10.1177/2473974x20931037 ◽

2020 ◽

Vol 4 (2) ◽

pp. 2473974X2093103 ◽

Cited By ~ 1

Author(s):

Caitlin Bertelsen ◽

Kevin Hur ◽

Margaret Nurimba ◽

Janet Choi ◽

Joseph R. Acevedo ◽

...

Keyword(s):

Blood Transfusion ◽

Length Of Stay ◽

Head And Neck ◽

Free Flap ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Control Group ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Flap Monitoring

Objectives Evaluate an enhanced recovery after surgery (ERAS)–based free flap management protocol implemented at our center. Study Design Prospective cohort study of patients after implementation of an ERAS-based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group. Setting Tertiary care academic medical center. Participants and Methods All patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30-day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared. Results Sixty-one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, P = .04) and postoperative (49.2% vs 27.2%, P = .026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P < .01) and ventilator support (63.9% vs 9.8%, P < .01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, P = .017). Length of stay, readmissions, and complication rates did not significantly differ between groups. Conclusion ERAS-based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor-intensive flap monitoring, without adverse effects on outcomes.

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Immediate Use of Uncuffed Tracheostomy after Free Flap Reconstruction of the Head and Neck

Otolaryngology ◽

10.1177/0194599818766009 ◽

2018 ◽

Vol 159 (2) ◽

pp. 242-248 ◽

Cited By ~ 1

Author(s):

Priyesh N. Patel ◽

Al C. Valmadrid ◽

Daniel Y. Hong ◽

David O. Francis ◽

Michael W. Sim ◽

...

Keyword(s):

Length Of Stay ◽

Oral Cavity ◽

Hospital Stay ◽

Head And Neck ◽

Free Flap ◽

Length Of Hospital Stay ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Respiratory Complications ◽

Immediate Placement

Objective To determine if immediate postoperative uncuffed tracheostomy placement following oral cavity or oropharyngeal head and neck free flap reconstruction is associated with shorter hospital length of stay and higher inpatient decannulation rates without an increase in respiratory complications, as compared with immediate placement of cuffed tracheostomy. Study Design Retrospective cohort. Setting Tertiary referral center. Subjects and Methods Patients were included if they underwent free flap reconstruction for oral cavity or oropharyngeal squamous cell carcinoma and had an intraoperative tracheostomy placed between 2005 and 2016. In 2012, head and neck surgeons changed from routine placement of cuffed to uncuffed tracheostomy tubes immediately after free flap reconstruction. This study compares length of hospital stay, inpatient decannulation rates, and respiratory complications between patients who had cuffed and uncuffed tracheostomies. Analysis of variance and chi-square test were used to examine continuous and categorical variables, respectively. Multivariable regression analyses were performed to determine whether cuff status was independently associated with primary outcomes of length of hospital stay, decannulation, and respiratory complications. Results Of 752 patients who underwent free flap reconstruction, 493 patients met inclusion criteria (cuffed, n = 366; uncuffed, n = 127). Patient variables (ie, age, sex, body mass index, prior chemoradiation) and tumor characteristics (ie, location, stage) did not differ significantly between groups. Adjusted analysis showed that an uncuffed tracheostomy (vs a cuffed tracheostomy) was associated with shorter length of stay (7.7 vs 9.7 days, P < .001) and did not increase the rate of respiratory complications. Conclusion Immediate placement of a uncuffed tracheostomy after oral cavity or oropharyngeal free flap reconstruction is associated with shorter hospital stays without an increase in respiratory complications.

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