Dang Sophia, Hashimi Basil, Tang Anthony, Kubik Mark W, Solari Mario G, Sridharan Shaum S
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
Laryngoscope. 2025 Jan;135(1):110-117. doi: 10.1002/lary.31665. Epub 2024 Jul 30.
Head and neck oncologic resections with microvascular reconstruction are lengthy and complex procedures with inefficiencies in the operating room (OR) associated with increased complications and higher costs. Multidisciplinary care has become increasingly used to provide improved care for complex patients; however, the potential role of this has not yet been studied in head and neck microvascular free flap procedures.
Patients between 2016 and 2022 treated before and after implementation of the conference were included. Primary outcome was total procedure time (TPT). Demographics, operative details, and postoperative complications were also collected.
233 patients were included in the preconference group and 330 in the post-conference group. Preconference mean (SD) age was 61.6 (12) years versus 62.9 (12) years in the post-conference group. The post-conference group was associated with shorter mean (SD) TPT (629 [117] vs. 719 [134] minutes), less mean (SD) estimated blood loss (ESD) (230 [201] mL vs. 306 [211] mL), fewer prolonged lCU stays (>1 day), and fewer returns to the operating room (RTOR). The post-conference group was associated with TPT ≤9 h (p < 0.001) on multivariate analysis. Factors associated with TPT greater than 9 h include history of head and neck radiation (p = 0.003), bony reconstruction (p = 0.05), stage IVa (p = 0.009), and stage IVb cancer (p < 0.001).
Implementation of the multidisciplinary conference in head and neck surgery was associated with reduced TPT and reduced OR return. Our study suggests preoperative planning conferences may improve surgical efficiency and outcomes in head and neck oncologic resections with microvascular free flap reconstruction.
3 Laryngoscope, 135:110-117, 2025.
头颈部肿瘤切除并进行微血管重建是冗长且复杂的手术，手术室存在效率低下的问题，这与并发症增加和成本升高相关。多学科护理越来越多地用于为复杂患者提供更好的护理；然而，其在头颈部微血管游离皮瓣手术中的潜在作用尚未得到研究。
纳入2016年至2022年期间在会议实施前后接受治疗的患者。主要结局是总手术时间（TPT）。还收集了人口统计学资料、手术细节和术后并发症。
会前组纳入233例患者，会后组纳入330例患者。会前组的平均（标准差）年龄为61.6（12）岁，会后组为62.9（12）岁。会后组的平均（标准差）总手术时间较短（629[117]分钟对719[134]分钟），平均（标准差）估计失血量较少（230[201]毫升对306[211]毫升），入住重症监护病房时间延长（>1天）的情况较少，返回手术室的次数较少。多因素分析显示，会后组的总手术时间≤9小时（p<0.001）。与总手术时间超过9小时相关的因素包括头颈部放疗史（p=0.003）、骨重建（p=0.05）、IVa期（p=0.009）和IVb期癌症（p<0.001）。
头颈部手术中实施多学科会议与总手术时间缩短和手术室返回率降低相关。我们的研究表明，术前规划会议可能会提高头颈部肿瘤切除并进行微血管游离皮瓣重建手术的效率和结局。
3《喉镜》，135:110 - 117，2025年。
