Improved Resource Use following Vascularized Tissue Transfer: Mandatory Intensive Care Unit Stay Is Unnecessary

Abstract

Objectives:

1) Analyze the impact of elimination of mandatory intensive care stay for patients following vascularized tissue transfer for reconstruction of defects following major head and neck surgical procedures. 2) Propose efficient, cost effective hospital pathways for care of patients following vascularized tissue transfer. 3) Demonstrate portability of such pathways between academic and community based practices.

Methods:

We performed a retrospective study involving two groups of adult patients who underwent vascularized free tissue transfer at a head and neck oncology practice at an academic and a community based hospital between July 2007 and June 2012. The first group of patients mandatorily received their immediate postoperative care in an intensive care unit. Following the institution of a specialized head and neck surgical unit, group 2 was cared for in a protocol driven, non intensive care unit setting. Outcomes and costs were compared between the two patient groups.

Results:

There was no adverse impact on rate of flap failure, inpatient mortality, and overall length of hospitalization. In contrast, a significant reduction in healthcare costs was observed when patients were routinely admitted to the head and neck surgery floor, instead of mandatory postoperative intensive care stay.

Conclusions:

1) Mandatory admission to intensive care following vascularized free tissue transfer for flap monitoring is unnecessary. 2) Results can be replicated in both an academic and community hospital setting.