Cost and clinical outcomes of postoperative intensive care unit versus general floor management in head and neck free flap reconstructive surgery patients
| Autor: | Jaime A. Aponte-Ortiz, Sue L. Visscher, Bijan J. Borah, Jeffrey R. Janus, Joshua R. Labott, John P. Marinelli, Alexandra J. Greenberg-Worisek, Grant M. Spears, Jeffrey C. Mecham, Matthew M. May, Eric J. Moore |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Reconstructive surgery medicine.medical_specialty Free flap Free Tissue Flaps law.invention 03 medical and health sciences 0302 clinical medicine law Patients' Rooms medicine Humans In patient 030223 otorhinolaryngology Head and neck Aged Postoperative Care business.industry Medical record General surgery Head and neck cancer Odds ratio Health Care Costs Middle Aged Plastic Surgery Procedures medicine.disease Intensive care unit Intensive Care Units Treatment Outcome Otorhinolaryngology Head and Neck Neoplasms 030220 oncology & carcinogenesis Female business |
| Zdroj: | American journal of otolaryngology. 42(5) |
| ISSN: | 1532-818X |
| Popis: | To compare clinical, surgical, and cost outcomes in patients undergoing head and neck free-flap reconstructive surgery in the setting of postoperative intensive care unit (ICU) against general floor management.Retrospective analysis of head and neck free-flap reconstructive surgery patients at a single tertiary academic medical center. Clinical data was obtained from medical records. Cost data was obtained via the Mayo Clinic Rochester Cost Data Warehouse, which assigns Medicare reimbursement rates to all professional billed services.A total of 502 patients were included, with 82 managed postoperatively in the ICU and 420 on the general floor. Major postoperative outcomes did not differ significantly between groups (Odds Ratio[OR] 1.54; p = 0.41). After covariate adjustments, patients managed in the ICU had a 3.29 day increased average length of hospital stay (Standard Error 0.71; p 0.0001) and increased need for take-back surgery (OR 2.35; p = 0.02) when compared to the general floor. No significant differences were noted between groups in terms of early free-flap complications (OR 1.38;p = 0.35) or late free-flap complications (Hazard Ratio 0.81; p = 0.61). Short-term cost was $8772 higher in the ICU (range = $5640-$11,903; p 0.01). Long-term cost did not differ significantly.Postoperative management of head and neck oncologic free-flap patients in the ICU does not significantly improve major postoperative outcomes or free-flap complications when compared to general floor care, but does increase short-term costs. General floor management may be appropriate when cardiopulmonary compromise is not present. |
| Databáze: | OpenAIRE |
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