Discharge Delay in Head and Neck Free Flap Surgery: Risk Factors and Strategies to Minimize Hospital Days

2019 ◽  
Vol 160 (5) ◽  
pp. 829-838 ◽  
Author(s):  
Dustin M. Lang ◽  
Deepa Danan ◽  
Raja Sawhney ◽  
Natalie L. Silver ◽  
Varun V. Varadarajan ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Quality Metric ◽  
Factors Associated ◽  
Free Flap Surgery ◽  
Hospital Resources ◽  
Hospital Days

Objective Length of stay (LOS) includes time medically necessary in the hospital and time waiting for discharge (DC) afterward. This DC delay is determined in head and neck free flap patients. Reasons for and factors leading to DC delay, as well as associated adverse outcomes, are elucidated. Methods Retrospective chart review was performed for all head and neck free flap surgeries from 2012 to 2017. Data including demographics, comorbidities, and perioperative factors were collected. Regression analyses were performed to identify factors associated with DC delay. Results In total, 264 patients were included. Mean total LOS was 13.1 days. DC delay occurred in 65% of patients with a mean of 4.8 days. Factors associated with DC delay on univariate analysis included Medicaid/self-pay insurance, DC to a facility, and not having children ( P < .05). Multivariate analysis showed prolonged medically necessary LOS and surgery on a Monday/Friday ( P < .05) were associated with DC delay. Top reasons for DC delay included case management shortages, rejection by facility, and awaiting supplies. Eleven percent experienced complications during the DC delay. Discussion DC delay can add days and complications to the LOS. Prevention begins preoperatively with DC planning involving the patient’s closest family. Understanding limitations of the patient’s insurance may help plan DC destination. Optimizing hospital resources when available should be a focus. Implications for Practice Head and neck free flap patients require a team of teams unified in optimizing quality of care. DC delay is a novel quality metric reflecting the team’s overall performance. Through strategic DC planning and capitalizing on available resources, DC delay can be minimized.

Postoperative Tachycardia in Head and Neck Microvascular Free Flap Patients

2019 ◽  
Vol 160 (6) ◽  
pp. 1019-1022 ◽  
Author(s):  
Andrea Ziegler ◽  
Alexander Schneider ◽  
Amy Pittman ◽  
Eric Thorpe
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Vascular Complication ◽  
Adverse Outcomes ◽  
Free Flap Surgery ◽  
Increased Risk ◽  
Microvascular Free Flap

Objective The goal of this study was to determine the incidence of postoperative tachycardia and its predictive value of complications in patients following microvascular free flap surgery in the head and neck. Study Design Retrospective chart review. Setting Single tertiary care academic medical center. Subjects and Methods All patients who underwent a microvascular free flap of the head and neck by surgeons in the department of otolaryngology from 2013 to 2017 were included in this study. Results Of the 344 who patients met inclusion criteria, 40.4% had a maximum heart rate (HR) of the hospitalization over 110 beats per minute (bpm). Patients with a maximum HR greater than 110 bpm were 19 times more likely to experience a composite vascular complication (myocardial infarction, myocardial necrosis, or pulmonary embolism) than patients with a maximum HR <110 bpm ( P = .0063). Patients with a history of chronic kidney disease were also noted to have an increased risk of experiencing a postoperative composite vascular event. Conclusion Postoperative tachycardia is significantly associated with adverse outcomes and should not be dismissed as a normal variant. Identifying patients at an increased risk of having an underlying complication can help guide interpretation, workup, and management of postoperative patients in the head and neck population.

scholarly journals Adverse Outcomes Following Free Tissue Transfer: A 3-year Experience From a Major Referral Centre

2021 ◽  
Author(s):  
Silas Nann ◽  
Jia Miin Yip ◽  
Tyler Glanville ◽  
Nicholas Marshall
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Case Series ◽  
Free Flaps ◽  
Adverse Outcomes ◽  
The Body ◽  
Complication Rates ◽  
Retrospective Case ◽  
Tissue Transfer ◽  
Free Flap Surgery

Abstract BackgroundFree tissue transfer encompasses a variety of techniques by which tissue is moved to another region of the body, with anastomosis of the divided artery and vein. Currently, success rates are reported at 91-99% [1], however, little is known regarding predictors for adverse outcomes.We aim at identifying predictors for negative outcomes following free flap surgery; and predict that elderly patients and patients with head and neck free flaps will have inferior outcomes due to comorbidity.MethodsThis is a retrospective case series. All free flap surgeries between 02/2018 to 02/2021 were identified using the electronic operation record system at Flinders Medical Centre. Chi squared hypothesis testing assessed patient factors and implications on outcome. Results67 patients of varying demographics were included in this study. The odds of wound infection was much higher in patients aged older than 65 (OR: 4.1 (95%CI 1.24-13.6, z-score: 2.31, p=0.017)). The odds of unplanned reoperation was also higher in this population (OR: 13.7 (95%CI 1.42-132.9, p=0.0053)). Free flap location was significant in determining whether patients would require a subsequent blood transfusion (p=0.0071). Head and neck patients did not experience a higher rate of adverse events.ConclusionPatients aged 65 and older are more likely to require treatment for infection and more often require reoperation because of flap related issues. Patients with limb free flaps are more likely to require transfusions. Head and neck patients did not have higher complication rates.

Designing a Masterclass in free flap surgery for head and neck surgeons: Our experience

Microsurgery ◽  
2020 ◽  
Vol 40 (8) ◽  
pp. 929-929
Author(s):  
Karim Tewfik ◽  
Alfonso Manfuso ◽  
Lazzaro Cassano ◽  
Nicola Pederneschi ◽  
Chiara Copelli
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Flap Surgery ◽  
Free Flap Surgery

Optimizing value in head and neck cancer free flap surgery

2019 ◽  
Vol 27 (5) ◽  
pp. 413-419 ◽  
Author(s):  
Harrison Cash ◽  
Marianne Abouyared ◽  
Jeffrey J. Houlton
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Flap Surgery ◽  
Free Flap Surgery

Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

2018 ◽  
Vol 159 (5) ◽  
pp. 817-823 ◽  
Author(s):  
Meghan M. Crippen ◽  
Jacob S. Brady ◽  
Alexander M. Mozeika ◽  
Jean Anderson Eloy ◽  
Soly Baredes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Postoperative Complications ◽  
Head And Neck ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Increased Risk

Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.

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