White Laura J, Zhang Hongzheng, Strickland Kaitlyn F, El-Deiry Mark W, Patel Mihir R, Wadsworth J Tradnor, Chen Amy Y
Department of Otolaryngology-Head and Neck Surgery, Emory University Hospital Midtown, Atlanta, Georgia.
JAMA Otolaryngol Head Neck Surg. 2015 Dec;141(12):1052-8. doi: 10.1001/jamaoto.2015.0756.
Cost containment is at the forefront of responsible health care delivery. One way to decrease costs is to decrease hospital length of stay (LOS). Data are lacking on factors contributing to LOS in patients with head and neck cancer (HNC) undergoing fibular free-tissue reconstruction (FFTR) of head and neck defects.
To identify factors contributing to increased LOS following FFTR of head and neck defects in patients with HNC using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) methodology.
Retrospective medical record review, with reference to the ACS NSQIP form, of 30 consecutive patients with HNC undergoing FFTR of head and neck defects in a single tertiary academic institution from July 2013 through June 2014. Data were collected on demographic and tumor characteristics, preoperative risk factors, operative variables, and postoperative adverse events.
Factors associated with increased hospital LOS.
Median LOS was 10 days (range, 8-31 days), and patients were divided into 2 groups (LOS, ≤ 10 days [n = 16]; and LOS, >10 days [n = 14]). There were no significant differences in demographics, tumor characteristics, or preoperative medical comorbidities between the 2 groups. Univariate analysis demonstrated that operative time, ventilator dependence, wound event, and altered mental status were associated with longer LOS. Multivariate analysis revealed significant association with LOS greater than 10 days for operative time of longer than 11 hours (odds ratio [OR], 7.26; 95% CI, 1.12-47.29; P = .04) and ventilator dependence for more than 48 hours postoperatively (OR, 12.05; 95% CI, 1.06-137.43; P = .045).
Evaluated by the ACS NSQIP criteria, FFTR of head and neck defects in patients with HNC was associated with LOS longer than 10 days for procedures lasting longer than 11 hours and for patients who are ventilator dependent for more than 48 hours.
成本控制是负责任的医疗服务提供的首要任务。降低成本的一种方法是缩短住院时间（LOS）。目前缺乏关于接受头颈部缺损腓骨游离组织重建（FFTR）的头颈癌（HNC）患者住院时间相关因素的数据。
使用美国外科医师学会国家外科质量改进计划（ACS NSQIP）方法，确定HNC患者头颈部缺损FFTR后住院时间延长的相关因素。
对2013年7月至2014年6月在一家单一的三级学术机构中连续30例接受头颈部缺损FFTR的HNC患者进行回顾性病历审查，并参考ACS NSQIP表格。收集了人口统计学和肿瘤特征、术前危险因素、手术变量及术后不良事件的数据。
与住院时间延长相关的因素。
中位住院时间为10天（范围8 - 31天），患者被分为两组（住院时间≤10天[n = 16]；住院时间>10天[n = 14]）。两组在人口统计学、肿瘤特征或术前合并症方面无显著差异。单因素分析表明，手术时间、呼吸机依赖、伤口事件和精神状态改变与住院时间延长有关。多因素分析显示，手术时间超过11小时（比值比[OR]，7.26；95%可信区间[CI]，1.12 - 47.29；P = 0.04）以及术后呼吸机依赖超过小时（OR，12.05；95%CI，1.06 - 137.43；P = 0.045）与住院时间超过10天显著相关。
根据ACS NSQIP标准评估，对于手术时间超过11小时以及术后呼吸机依赖超过48小时的HNC患者，头颈部缺损FFTR与住院时间超过10天相关。
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