Factors Impacting Discharge Destination Following Head and Neck Microvascular Reconstruction.
Publication/Presentation Date
1-1-2023
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.
Volume
133
Issue
1
First Page
95
Last Page
104
ISSN
1531-4995
Published In/Presented At
Sweeny, L., Slijepcevic, A., Curry, J. M., Philips, R., Bonaventure, C. A., DiLeo, M., Luginbuhl, A. J., Crawley, M. B., Guice, K. M., McCreary, E., Buncke, M., Petrisor, D., & Wax, M. K. (2023). Factors Impacting Discharge Destination Following Head and Neck Microvascular Reconstruction. The Laryngoscope, 133(1), 95–104. https://doi.org/10.1002/lary.30149
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
35562185
Department(s)
Administration and Leadership
Document Type
Article