Factors Impacting Discharge Destination Following Head and Neck Microvascular Reconstruction

Larissa Sweeny; Allison Slijepcevic; Joseph M Curry; Ramez Philips; Caroline A Bonaventure; Michael DiLeo; Adam J Luginbuhl; Meghan B Crawley; Kelsie M Guice; Eleanor McCreary; Michelle Buncke; Daniel Petrisor; Mark K Wax

doi:10.1002/lary.30149

Factors Impacting Discharge Destination Following Head and Neck Microvascular Reconstruction

Laryngoscope. 2023 Jan;133(1):95-104. doi: 10.1002/lary.30149. Epub 2022 May 12.

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, U.S.A.
² Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
³ Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
⁴ School of Medicine, Louisiana State University Health Science Center - New Orleans, New Orleans, Louisiana, U.S.A.
⁵ Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center - New Orleans, New Orleans, Louisiana, U.S.A.
⁶ Oregon Health and Science University School of Medicine, Portland, Oregon, U.S.A.

PMID: 35562185
DOI: 10.1002/lary.30149

Abstract

Objective: Determine which variables impact postoperative discharge destination following head and neck microvascular free flap reconstruction.

Study design: Retrospective review of prospectively collected databases.

Methods: Consecutive patients undergoing head and neck microvascular free flap reconstruction between January 2010 and December 2019 (n = 1972) were included. Preoperative, operative and postoperative variables were correlated with discharge destination (home, skilled nursing facility [SNF], rehabilitation facility, death).

Results: The mean age of patients discharged home was lower (60 SD ± 13, n = 1450) compared to those discharged to an SNF (68 SD ± 14, n = 168) or a rehabilitation facility (71 SD ± 14, n = 200; p < 0.0001). Operative duration greater than 10 h correlated with a higher percentage of patients being discharged to a rehabilitation or SNF (25% vs. 15%; p < 0.001). Patients were less likely to be discharged home if they had a known history of cardiac disease (71% vs. 82%; p < 0.0001). Patients were less likely to be discharged home if they experienced alcohol withdrawal (67% vs. 80%; p = 0.006), thromboembolism (59% vs. 80%; p = 0.001), a pulmonary complication (46% vs. 81%; p < 0.0001), a cardiac complication (46% vs. 80%; p < 0.0001), or a cerebral vascular event (25% vs. 80%; p < 0.0001). There was no correlation between discharge destination and occurrence of postoperative wound infection, salivary fistula, partial tissue necrosis or free flap failure. Thirty-day readmission rates were similar when stratified by discharge destination.

Conclusion: There was no correlation with the anatomic site, free flap donor selection, or free flap survival and discharge destination. Patient age, operative duration and occurrence of a medical complication postoperatively did correlate with discharge destination.

Level of evidence: 4 Laryngoscope, 133:95-104, 2023.

Keywords: free flap; free flap failure; head and neck reconstruction; outcomes; surgical complications.

MeSH terms

Alcoholism* / complications
Free Tissue Flaps* / blood supply
Head and Neck Neoplasms* / complications
Head and Neck Neoplasms* / surgery
Humans
Patient Discharge
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
Substance Withdrawal Syndrome* / complications