Impact of Preoperative Risk Factors on Inpatient Stay and Facility Discharge After Free Flap Reconstruction

2021 ◽  
pp. 019459982110375
Author(s):  
Michael Hartley Freeman ◽  
Justin R. Shinn ◽  
Shanik J. Fernando ◽  
Douglas Totten ◽  
Jaclyn Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Head And Neck ◽  
Free Flap ◽  
Frailty Index ◽  
Multiple Logistic Regression Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Preoperative Risk ◽  
Preoperative Risk Factors

Objective To determine the preoperative risk factors most predictive of prolonged length of stay (LOS) or admission to a skilled nursing facility (SNF) or inpatient rehabilitation center (IPR) after free flap reconstruction of the head and neck. Study Design Retrospective cohort study. Setting Tertiary academic medical center. Methods Retrospective review of 1008 patients who underwent tumor resection and free flap reconstruction of the head and neck at a tertiary referral center from 2002 to 2019. Results Of 1008 patients (65.7% male; mean age of 61.4 years, SD 14.0 years), 161 (15.6%) were discharged to SNF/IPR, and the median LOS was 7 days. In multiple linear regression analysis, Charlson Comorbidity Index (CCI; P < .001), American Society of Anesthesiologists (ASA) classification ( P = .021), female gender ( P = .023), and inability to tolerate oral diet preoperatively ( P = .006) were statistically significantly related to increased LOS, whereas age, body mass index (BMI), modified frailty index (MFI), a history of prior radiation or chemotherapy, and home oxygen use were not. Multiple logistic regression analysis demonstrated that CCI (odds ratio [OR] = 1.119, confidence interval [CI] 1.023-1.223), age (OR = 1.082, CI 1.056-1.108), and BMI <19.0 (OR = 2.141, CI 1.159-3.807) were the only variables statistically significantly related to posthospital placement in an SNF or IPR. Conclusion Common tools for assessing frailty and need for additional care may be inadequate in a head and neck reconstructive population. CCI appears to be the best of the aggregate metrics assessed, with significant relationships to both LOS and placement in SNF/IPR.

Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck

Head & Neck ◽  
2010 ◽  
Vol 32 (10) ◽  
pp. 1345-1353 ◽  
Author(s):  
Rajan S. Patel ◽  
Stuart A. McCluskey ◽  
David P. Goldstein ◽  
Leonid Minkovich ◽  
Jonathan C. Irish ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Perioperative Complications ◽  
Flap Reconstruction ◽  
Prolonged Hospital Stay ◽  
Free Flap Reconstruction ◽  
Prolonged Hospital

scholarly journals Chronic opioid use following surgery for head and neck cancer patients undergoing free flap reconstruction

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Ashley Hinther ◽  
Alysha Rasool ◽  
Steven C. Nakoneshny ◽  
Shamir P. Chandarana ◽  
Robert Hart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Free Flap ◽  
Adjuvant Treatment ◽  
Flap Reconstruction ◽  
Opioid Use ◽  
Free Flap Reconstruction ◽  
Chronic Opioid Use ◽  
Opioid Users

Abstract Background Physician opioid-prescribing patterns have significant impacts on the current opioid crisis. Patients who use opioids in the postoperative period are at risk of developing chronic postoperative opioid use. This study determined the rate of chronic postoperative opioid use among head and neck cancer patients undergoing primary surgery with free-flap reconstruction. Additionally, this study identified major risk factors associated with the development of chronic postoperative opioid use. Methods A retrospective chart review was performed for all adults (age ≥ 18 years) undergoing primary head and neck surgical resection with free-flap reconstruction between January 2008 and December 2015. Patients were identified from a prospectively collected database, Otobase™. Data from the provincial drug insurance program were used to capture drug dispensing information to determine chronic opioid use at 3- and 12-months postoperatively. Data extracted from Otobase™ included patient demographics, social habits, clinical stage, pathological stage, type of surgery, and adjuvant treatment. Results The total cohort was comprised of 212 patients. Chronic opioid use at 3- and 12- months postoperatively was observed in 136 (64%) and 116 (55%) patients, respectively. Of the 212 patients, 85 patients (40%) were identified as preoperative opioid users and 127 were opioid naïve (60%). Of the 85 patients who were preoperative opioid users, 70 (82%) and 63 (77%) patients continued to use opioids 3- and 12-months postoperatively, respectively. The proportion of opioid-naïve patients who were using opioids at 3- and 12-months postoperatively was 52% (66 patients) and 42% (53 patients), respectively. Identified risk factors included preoperative opioid use, prior tobacco use, advanced pathologic T-stage, and adjuvant treatment. Conclusions Among head and neck cancer patients that have undergone major resection with free-flap reconstruction, the prevalence of chronic postoperative opioid users was considerable. Identified risk factors included preoperative opioid use, prior tobacco use, tumor stage, and adjuvant treatment. Graphical abstract

scholarly journals Availability of preoperative neutrophil-lymphocyte ratio to predict postoperative delirium after head and neck free-flap reconstruction: A retrospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254654
Author(s):  
Hirotaka Kinoshita ◽  
Junichi Saito ◽  
Daiki Takekawa ◽  
Tasuku Ohyama ◽  
Tetsuya Kushikata ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Intensive Care ◽  
Head And Neck ◽  
Logistic Regression Analysis ◽  
Free Flap ◽  
Postoperative Delirium ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Neutrophil Lymphocyte Ratio

Postoperative delirium (POD) is a well-recognized postoperative complication and is associated with increased morbidity and mortality. We investigated whether the preoperative neutrophil-lymphocyte ratio (NLR) could be an effective predictor of POD after head and neck free-flap reconstruction. This was a single-center, retrospective, observational study. We analyzed the perioperative data of patients who had undergone elective head and neck free-flap reconstruction surgery. POD was assessed with the Intensive Care Delirium Screening Checklist (ICDSC) during admission to our intensive care unit (ICU). POD was defined as an ICDSC score ≥4. Risk factors for POD were evaluated by univariate and multivariate logistic regression analysis. We included 97 patients. The incidence of POD was 20.6% (20/97). Significantly longer ICU stays were observed in the patients with POD compared to those without POD (median [interquartile range]: 5 [4–6] vs. 4 [4–5], p = 0.031). Higher preoperative NLR values (3 <NLR ≤4 and 4 <NLR) were significantly associated with higher ICDSC scores compared to NLR ≤1 (4 [2–4] vs. 1 [1–1], p = 0.027 and 4 [1–4] vs. 1 [1–1], p = 0.038, respectively). The multivariable logistic regression analysis revealed that only a preoperative NLR >3.0 (adjusted Odds Ratio: 23.6, 95% Confidence Interval: 6.6–85.1; p<0.001) was independently associated with POD. The multivariate area under the receiver operator curve was significantly greater for the E-PRE-DELIRIC model with NLR compared to the E-PRE-DELIRIC model (0.87 vs. 0.60; p<0.001). The preoperative NLR may be a good predictor of POD in patients undergoing head and neck free-flap reconstruction.

Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

Head & Neck ◽  
2017 ◽  
Vol 39 (8) ◽  
pp. 1578-1585 ◽  
Author(s):  
Nicholas B. Abt ◽  
Yanjun Xie ◽  
Sidharth V. Puram ◽  
Jeremy D. Richmon ◽  
Mark A. Varvares
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Head And Neck ◽  
Free Flap ◽  
Frailty Index ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

scholarly journals Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fu Cheng Bian ◽  
Xiao Kang Cheng ◽  
Yong Sheng An
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Blood Transfusion ◽  
Multivariate Logistic Regression ◽  
Preoperative Risk ◽  
Hip Fracture Surgery ◽  
Preoperative Risk Factors ◽  
Independent Risk Factors ◽  
Fracture Surgery

Abstract Background This study aimed to explore the preoperative risk factors related to blood transfusion after hip fracture operations and to establish a nomogram prediction model. The application of this model will likely reduce unnecessary transfusions and avoid wasting blood products. Methods This was a retrospective analysis of all patients undergoing hip fracture surgery from January 2013 to January 2020. Univariate and multivariate logistic regression analyses were used to evaluate the association between preoperative risk factors and blood transfusion after hip fracture operations. Finally, the risk factors obtained from the multivariate regression analysis were used to establish the nomogram model. The validation of the nomogram was assessed by the concordance index (C-index), the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curves. Results A total of 820 patients were included in the present study for evaluation. Multivariate logistic regression analysis demonstrated that low preoperative hemoglobin (Hb), general anesthesia (GA), non-use of tranexamic acid (TXA), and older age were independent risk factors for blood transfusion after hip fracture operation. The C-index of this model was 0.86 (95% CI, 0.83–0.89). Internal validation proved the nomogram model’s adequacy and accuracy, and the results showed that the predicted value agreed well with the actual values. Conclusions A nomogram model was developed based on independent risk factors for blood transfusion after hip fracture surgery. Preoperative intervention can effectively reduce the incidence of blood transfusion after hip fracture operations.

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