scholarly journals NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

OTO Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 2473974X1668569 ◽  
Author(s):  
Charles A. Riley ◽  
Blair M. Barton ◽  
Claire M. Lawlor ◽  
David Z. Cai ◽  
Phoebe E. Riley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Head And Neck ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Flap Surgery ◽  
Improvement Program ◽  
Free Flap Surgery ◽  
The Mean

Objective The National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost-effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses. Methods A case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center. Comorbidities and intraoperative and postoperative variables were collected. Predicted length of stay was tabulated with the NSQIP calculator. Results Thirty-five patients (70%) were male. The mean (SD) age was 67.2 (13.4) years. The mean (SD) length of stay (LOS) was 13.5 (10.3) days. The mean (SD) NSQIP-predicted LOS was 10.3 (2.2) days ( P = .027). Discussion The NSQIP calculator may be an inadequate predictor for LOS in patients with HNC undergoing free flap surgery. Additional study is necessary to determine the accuracy of this tool in this patient population. Implications for Practice: Head and neck surgeons performing free flap reconstructive surgery following tumor ablation may find that the NSQIP risk calculator underestimates the LOS in this population.

Utilization of microvascular couplers in salvage arterial anastomosis in head and neck free flap surgery: Case series and literature review

Head & Neck ◽  
2020 ◽  
Vol 42 (8) ◽  
Author(s):  
Michael M. Li ◽  
Akina Tamaki ◽  
Nolan B. Seim ◽  
Stephen Y. Kang ◽  
Enver Ozer ◽  
...  
Keyword(s):  
Literature Review ◽  
Head And Neck ◽  
Free Flap ◽  
Case Series ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Arterial Anastomosis

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

Plastic and burns surgery

2021 ◽  
pp. 647-668
Author(s):  
Brian Chen ◽  
Simon Davis ◽  
Fynn Maguire
Keyword(s):  
Surgical Procedures ◽  
Free Flap ◽  
Reconstructive Surgery ◽  
Breast Augmentation ◽  
Skin Grafting ◽  
Anaesthetic Management ◽  
Surgical Patients ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Surgical Operations

This chapter discusses the anaesthetic management of plastic and burns surgery. It begins with general principles of the anaesthetic management of plastic surgical patients. Surgical procedures covered include breast augmentation, reconstruction and reduction surgery; free flap surgery; liposuction; skin grafting and burns reconstructive surgery. The chapter includes pertinent anaesthetic features for a series of additional miscellaneous plastic surgical operations.

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.

Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions

2014 ◽  
Vol 151 (5) ◽  
pp. 791-796 ◽  
Author(s):  
Honda Hsu ◽  
Peir-Rong Chen ◽  
Sou-Hsin Chien ◽  
Jiunn-Tat Lee
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Tertiary Care ◽  
Case Series ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Head And Neck Reconstruction ◽  
Complication Rates ◽  
Recipient Site ◽  
The Mean

Objective Analyze the reliability, complications, and donor site morbidity of the proximal lateral leg flap when applied to head and neck reconstruction. Study Design Case series and chart review. Setting Tertiary care teaching hospital. Subjects and Methods Nineteen patients who underwent reconstruction of various head and neck defects with this flap were analyzed. The patient demographics, flap characteristics, method of donor site closure, scars of the donor area, complication rates, as well as functional results at the recipient site were assessed. Results The flap size ranged from 4 × 4 cm to 11 × 8 cm. Vascular pedicle length ranged from 5 to 9 cm. The mean distance of the perforator from the fibula head was 9.2 cm. The mean thickness of this flap was 5.5 mm. All the donor wounds were closed primarily. The flap survival rate was 100%. Conclusion This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.

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