School of Medicine, University of California, San Francisco, California, U.S.A.
Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California, U.S.A.
Laryngoscope. 2021 Jun;131(6):E1821-E1829. doi: 10.1002/lary.29382. Epub 2021 Jan 13.
OBJECTIVE/HYPOTHESIS: For patients undergoing microvascular free tissue transfer (MFTT), we evaluated risk factors and financial implications of operating room (OR) take-back procedures.
Retrospective review at a tertiary care center.
Patients who underwent MFTT for head and neck reconstruction from 2011 to 2018 were identified. We compared hospital length of stay and overall costs associated with OR take-back procedures. Multivariable regression analysis evaluated factors associated with OR take-backs during the same hospitalization.
A total of 727 free flaps were reviewed, and 70 OR take-backs (9.6%) were identified. Mean total length of stay (LOS) in the ICU was 3.4 days versus 6.7 days for non-take-back and take-back flaps, respectively (P < .001). Mean total LOS on the regular floor was 6.3 days versus 13.1 days, respectively (P < .001). This resulted in a cost differential of $33,507 (94.3% increase relative to non-take-back flaps). The total cost associated with an OR take-back was $39,786. Hematomas were the most common cause of take-backs and wound dehiscence was associated with the highest costs. On multivariable analysis, higher ASA class (OR, 2.06; 95% CI, 1.11-3.99; P = .026) and shorter ischemia times (OR, 0.52; 95% CI, 0.29-0.95; P = .030) were independently associated with increased risk of take-backs.
OR take-backs infrequently occur but are associated with a significant increase in financial burden when compared to free flap cases not requiring OR take-back. The large majority of the cost differential lies in a substantial increase of ICU and floor LOS for take-back flaps when compared to non-take-back flaps.
4 Laryngoscope, 131:E1821-E1829, 2021.
目的/假设：对于接受显微血管游离组织移植（MFTT）的患者，我们评估了手术室（OR）收回程序的风险因素和财务影响。
在三级护理中心进行的回顾性研究。
确定了 2011 年至 2018 年间接受头颈部重建的 MFTT 患者。我们比较了与 OR 收回程序相关的住院时间和总费用。多变量回归分析评估了同一住院期间与 OR 收回相关的因素。
共回顾了 727 例游离皮瓣，发现 70 例 OR 收回（9.6%）。非收回和收回皮瓣的 ICU 总住院时间（LOS）分别为 3.4 天和 6.7 天（P<.001）。普通病房的总 LOS 分别为 6.3 天和 13.1 天（P<.001）。这导致成本差异为 33507 美元（与非收回皮瓣相比增加了 94.3%）。OR 收回的总费用为 39786 美元。血肿是最常见的收回原因，而伤口裂开与最高的成本相关。多变量分析显示，较高的 ASA 分级（OR，2.06；95%CI，1.11-3.99；P=.026）和较短的缺血时间（OR，0.52；95%CI，0.29-0.95；P=.030）与收回风险增加独立相关。
OR 收回虽不常见，但与无需 OR 收回的游离皮瓣病例相比，会显著增加财务负担。与非收回皮瓣相比，收回皮瓣 ICU 和普通病房 LOS 的大幅增加是成本差异的主要原因。
4 级喉镜，131：E1821-E1829，2021 年。
