Wallner Juergen, Schwaiger Michael, Edmondson Sarah-Jayne, Mischak Irene, Egger Jan, Feichtinger Matthias, Zemann Wolfgang, Pau Mauro
Department of Oral & Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria.
Department of Cranio-Maxillofacial Surgery, AZ Monica and the University Hospital Antwerp, 2018 Antwerp, Belgium.
Cancers (Basel). 2021 Aug 4;13(16):3937. doi: 10.3390/cancers13163937.
This study aimed to investigate the effect of certain pre-operative parameters directly on the post-operative intensive care unit (ICU)-length of stay (LOS), in order to identify at-risk patients that are expected to need prolonged intensive care management post-operatively.
Retrospectively, patients managed in an ICU after undergoing major oral and maxillofacial surgery were analyzed. Inclusion criteria entailed: age 18-90 years, major primary oral cancer surgery including tumor resection, neck dissection and microvascular free flap reconstruction, minimum operation time of 8 h. Exclusion criteria were: benign/borderline tumors, primary radiation, other defect reconstruction than microvascular, treatment at other centers. Separate parameters used within the clinical routine were set in correlation with ICU-LOS, by applying single testing calculations (-tests, variance analysis, correlation coefficients, effect sizes) and a valid univariate linear regression model. The primary outcome of interest was ICU-LOS.
This study included a homogenous cohort of 122 patients. Mean surgery time was 11.4 (±2.2) h, mean ICU-LOS was 3.6 (±2.6) days. Patients with pre-operative renal dysfunction ( < 0.001), peripheral vascular disease-PVD ( = 0.01), increasing heart failure-NYHA stage categories ( = 0.009) and higher-grade categories of post-operative complications ( = 0.023) were identified as at-risk patients for a significantly prolonged post-operative ICU-LOS.
At-risk patients are prone to need a significantly longer ICU-LOS than others. These patients are those with pre-operative severe renal dysfunction, PVD and/or high NYHA stage categories. Confounding parameters that contribute to a prolonged ICU-LOS in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.
本研究旨在直接调查某些术前参数对术后重症监护病房（ICU）住院时间（LOS）的影响，以识别术后预计需要长期重症监护管理的高危患者。
对接受大型口腔颌面外科手术后在ICU接受治疗的患者进行回顾性分析。纳入标准包括：年龄18 - 90岁，主要原发性口腔癌手术，包括肿瘤切除、颈部清扫和微血管游离皮瓣重建，最短手术时间8小时。排除标准为：良性/交界性肿瘤、原发性放疗、微血管以外的其他缺损重建、在其他中心治疗。通过应用单测试计算（t检验、方差分析、相关系数、效应量）和有效的单变量线性回归模型，将临床常规中使用的单独参数与ICU-LOS进行相关性设定。感兴趣的主要结果是ICU-LOS。
本研究纳入了122例同质队列患者。平均手术时间为11.4（±2.2）小时，平均ICU-LOS为3.6（±2.6）天。术前肾功能不全（P<0.001）、外周血管疾病（PVD，P = 0.01）、心力衰竭NYHA分级增加（P = 0.009）以及术后并发症分级较高（P = 0.023）的患者被确定为术后ICU-LOS显著延长的高危患者。
高危患者术后在ICU的住院时间明显长于其他患者。这些患者是术前有严重肾功能不全、外周血管疾病和/或NYHA分级较高的患者。与其他变量共同导致ICU-LOS延长的混杂参数包括年龄较大、手术时间延长、慢性阻塞性肺疾病和术中输血。
