Tamplen Matthew L, Tamplen Jesse, Torrecillas Vanessa, Seth Rahul, Ricceri Santo, Hemmat Shirin, Heaton Chase, Ryan William R, Knott P Daniel
Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
Lean Transformation Office, University of California San Francisco, San Francisco, California.
J Reconstr Microsurg. 2017 May;33(4):252-256. doi: 10.1055/s-0036-1597757. Epub 2017 Jan 6.
To evaluate the role of hospital setting (standalone cancer center vs. large multidisciplinary hospital) on free tissue transfer (FTT) outcomes for head and neck reconstruction. Medical records were reviewed of 180 consecutive patients undergoing FTT for head and neck reconstruction. Operations occurred at either a standalone academic cancer center ( = 101) or a large multidisciplinary academic medical center ( = 79) by the same surgeons. Patient outcomes, operative comparisons, and hospital costs were compared between the hospital settings. The cancer center group had higher mean age (65.2 vs. 60 years; = 0.009) and a shorter mean operative time (12.3 vs. 13.2 hours; = 0.034). Postoperatively, the cancer center group had a significantly shorter average ICU stay (3.45 vs. 4.41 days; < 0.001). There were no significant differences in medical or surgical complications between the groups. Having surgery at the cancer center was the only significant independent predictor of a reduced ICU stay on multivariate analysis (Coef 0.73; < 0.020). Subgroup analysis, including only patients with cancer of the aerodigestive tract, demonstrated further reduction in ICU stay for the cancer center group (3.85 vs. 5.1 days; < 0.001). A cost analysis demonstrated that the reduction in ICU saved $223,816 for the cancer center group. Standalone subspecialty cancer centers are safe and appropriate settings for FTT. We found both reduced operative time and ICU length of stay, both of which contributed to lower overall costs. These findings challenge the concept that FTT requires a large multidisciplinary hospital. 4.
评估医院环境（独立癌症中心与大型多学科医院）对头颈部重建中游离组织移植（FTT）结果的作用。回顾了180例连续接受FTT进行头颈部重建患者的病历。手术由同一组外科医生在独立的学术癌症中心（n = 101）或大型多学科学术医疗中心（n = 79）进行。比较了不同医院环境下的患者结局、手术情况及医院成本。癌症中心组患者平均年龄较高（65.2岁对60岁；P = 0.009），平均手术时间较短（12.3小时对13.2小时；P = 0.034）。术后，癌症中心组患者平均ICU住院时间显著缩短（3.45天对4.41天；P < 0.001）。两组在医疗或手术并发症方面无显著差异。多因素分析显示，在癌症中心进行手术是ICU住院时间缩短的唯一显著独立预测因素（系数0.73；P < 0.020）。亚组分析仅纳入上消化道癌症患者，结果显示癌症中心组患者的ICU住院时间进一步缩短（3.85天对5.1天；P < 0.001）。成本分析表明，癌症中心组因ICU住院时间缩短节省了223,816美元。独立的专科癌症中心是进行FTT的安全且合适的环境。我们发现手术时间和ICU住院时间均缩短，这两者都有助于降低总体成本。这些发现挑战了FTT需要大型多学科医院的观念。 4.
