Varadarajan Varun V, Sawhney Raja, Bernard Stewart H, Boyce Brian, Lang Dustin M, Balamohan Sanjeev, Baskin Robert M, Dziegielewski Peter T
Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A.
University of Florida Health Cancer Center, Gainesville, Florida, U.S.A.
Laryngoscope. 2018 Feb;128(2):336-342. doi: 10.1002/lary.26658. Epub 2017 May 12.
OBJECTIVES/HYPOTHESIS: Head and neck free flap patients require complex postoperative care. The quality of care for these patients often depends on their management from the time they leave the operating room. The purpose of this study was to investigate the impact of a postoperative inpatient coordinator (IC) for head and free flap patients on quality outcomes: length of stay (LOS), 30-day unplanned return to the emergency department (30dRED), 30-day unplanned readmissions (30dUR), and complication rates.
Retrospective cohort study.
One hundred eighty-eight consecutive patients who underwent head and neck free flap surgery between January 2012 and January 2016 were reviewed using a prospective database. Patients had an IC for their entire hospitalization (group 1) or for less than their entire hospitalization (group 2). Logistic regression analysis was performed to identify risk factors for quality outcomes.
Mean LOS was 13.8 days and 17.3 days in groups 1 and 2, respectively (P = .002). The 30dRED rate was 12% and 22%, respectively (P = .04). Group 2 had an increased LOS by 4.1 days (P = .001) and a 2.4 fold increased 30dRED (P = .03). 30dUR and complications were not influenced by the IC (P > .05).
An IC may help decrease LOS and 30dRED in head and neck free flap patients.
目的/假设：头颈部游离皮瓣患者术后需要复杂的护理。这些患者的护理质量通常取决于他们离开手术室后的管理。本研究的目的是调查头颈部游离皮瓣患者术后住院协调员（IC）对质量结果的影响：住院时间（LOS）、30天内非计划返回急诊科（30dRED）、30天内非计划再入院（30dUR）和并发症发生率。
回顾性队列研究。
使用前瞻性数据库对2012年1月至2016年1月期间连续188例行头颈部游离皮瓣手术的患者进行回顾。患者在整个住院期间有IC（第1组）或住院时间不足整个住院期（第2组）。进行逻辑回归分析以确定质量结果的风险因素。
第1组和第2组的平均住院时间分别为13.8天和17.3天（P = 0.002）。30dRED率分别为12%和22%（P = 0.04）。第2组住院时间增加4.1天（P = 0.001），30dRED增加2.4倍（P = 0.03）。30dUR和并发症不受IC影响（P>0.05）。
IC可能有助于减少头颈部游离皮瓣患者的住院时间和30dRED。
4。《喉镜》，2018年，第128卷：336 - 342页。
