Early discharge after free-tissue transfer does not increase adverse events.

Autor: Hanick A; Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA., Meleca JB; Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA. Electronic address: melecaj@ccf.org., Fritz MA; Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2020 Mar - Apr; Vol. 41 (2), pp. 102374. Date of Electronic Publication: 2019 Dec 10.
DOI: 10.1016/j.amjoto.2019.102374
Abstrakt: Introduction: Demonstrate that carefully selected free flap patients may be discharged early after surgery without increasing the rates of postoperative complications or readmissions.
Methods: Based on a published article in Laryngoscope 2016 of 51 free-tissue transfers, a retrospective chart review was performed on an expanded cohort who underwent free-tissue transfer for head and neck reconstruction between February 2010 and May 2018 and discharged by postoperative day 3.
Results: 101 patients who underwent 104 free flaps with average age of 56 (3-84) years old were reviewed. Free flap indications included orbital and maxillary defects (n = 22), palatal defects (n = 16), nasal and septal defects (n = 16), cranioplasty and scalp defects (n = 16), mandibular defects due to osteoradionecrosis (n = 14), facial contouring and parotid defects (n = 12), and complex postsurgical and radiotherapy wounds or fistula closure (n = 8). Free flaps performed were anterolateral thigh (n = 97), radial forearm (n = 2), serratus (n = 2), latissimus (n = 1), fibula (n = 1) and supraclavicular (n = 1). The recipient vessels used via minimal access approaches were facial (n = 43), superficial temporal (n = 29), angular (n = 20) and others. There were 3 flap failures (2.9%) recognized in follow-up. No flap failures or perioperative complications were associated with early discharge. There were only 2 patients readmitted and 1 watched in observation within 30 days postoperatively.
Conclusion: An updated review of our institutional experience with more than double the cohort size substantiates previous conclusions that early discharge after free-tissue transfer is a safe option in select patients. Moreover, earlier discharge is a critical management choice that reduces cost and decreases hospital-related adverse events.
Competing Interests: Declaration of competing interest The authors listed above have no conflicts of interest to disclose.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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