Center for Clinical and Translational Science, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; University of Puerto Rico School of Medicine, PO Box 365067, San Juan, PR 00936-5067, USA. Electronic address: http://t.co/JAO_MDMS.
Department of Epidemiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. Electronic address: http://t.co/AJGreenbergPhD.
Am J Otolaryngol. 2021 Sep-Oct;42(5):103029. doi: 10.1016/j.amjoto.2021.103029. Epub 2021 Apr 13.
To compare clinical, surgical, and cost outcomes in patients undergoing head and neck free-flap reconstructive surgery in the setting of postoperative intensive care unit (ICU) against general floor management.
Retrospective analysis of head and neck free-flap reconstructive surgery patients at a single tertiary academic medical center. Clinical data was obtained from medical records. Cost data was obtained via the Mayo Clinic Rochester Cost Data Warehouse, which assigns Medicare reimbursement rates to all professional billed services.
A total of 502 patients were included, with 82 managed postoperatively in the ICU and 420 on the general floor. Major postoperative outcomes did not differ significantly between groups (Odds Ratio[OR] 1.54; p = 0.41). After covariate adjustments, patients managed in the ICU had a 3.29 day increased average length of hospital stay (Standard Error 0.71; p < 0.0001) and increased need for take-back surgery (OR 2.35; p = 0.02) when compared to the general floor. No significant differences were noted between groups in terms of early free-flap complications (OR 1.38;p = 0.35) or late free-flap complications (Hazard Ratio 0.81; p = 0.61). Short-term cost was $8772 higher in the ICU (range = $5640-$11,903; p < 0.01). Long-term cost did not differ significantly.
Postoperative management of head and neck oncologic free-flap patients in the ICU does not significantly improve major postoperative outcomes or free-flap complications when compared to general floor care, but does increase short-term costs. General floor management may be appropriate when cardiopulmonary compromise is not present.
比较头颈部游离皮瓣重建手术后在重症监护病房（ICU）与普通病房管理下的临床、手术和成本结果。
对单中心三级学术医疗中心的头颈部游离皮瓣重建手术患者进行回顾性分析。临床数据来自病历。成本数据通过梅奥诊所罗切斯特成本数据仓库获得，该数据库将医疗保险报销率分配给所有计费的专业服务。
共纳入 502 例患者，82 例在 ICU 术后管理，420 例在普通病房管理。主要术后结局两组间无显著差异（优势比[OR]1.54；p=0.41）。调整协变量后，与普通病房相比，ICU 管理的患者平均住院时间延长 3.29 天（标准误差 0.71；p<0.0001），需要再次手术的比例增加（OR 2.35；p=0.02）。两组间早期游离皮瓣并发症（OR 1.38；p=0.35）或晚期游离皮瓣并发症（风险比 0.81；p=0.61）无显著差异。ICU 组短期成本增加 8772 美元（范围 5640-11903 美元；p<0.01）。长期成本无显著差异。
与普通病房护理相比，头颈部肿瘤游离皮瓣患者术后在 ICU 管理并不能显著改善主要术后结局或游离皮瓣并发症，但会增加短期成本。当不存在心肺功能受损时，普通病房管理可能是合适的。
