TY - JOUR
T1 - Impact of Preoperative Risk Factors on Inpatient Stay and Facility Discharge After Free Flap Reconstruction
AU - Freeman, Michael Hartley
AU - Shinn, Justin R.
AU - Fernando, Shanik J.
AU - Totten, Douglas
AU - Lee, Jaclyn
AU - Malenke, Jordan A.
AU - Wood, C. Burton
AU - Langerman, Alexander J.
AU - Mannion, Kyle
AU - Sinard, Robert J.
AU - Rohde, Sarah L.
N1 - Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2021.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - care prediction
KW - comorbidities
KW - complications
KW - frailty
KW - free flap reconstruction
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U2 - 10.1177/01945998211037541
DO - 10.1177/01945998211037541
M3 - Article
C2 - 34399644
AN - SCOPUS:85112739062
SN - 0194-5998
VL - 166
SP - 454
EP - 460
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 3
ER -