Outcomes Comparison of Free Tissue Transfers of the Head and Neck at Three Different Hospital Settings: Lessons Learned

Abstract

Objective: To test the hypothesis that there are disparate outcomes of patients undergoing free tissue transfers of the head and neck in 3 different hospital populations; private, public (county) and veterans administration (VA). Study Design: Retrospective chart review. Methods: Reviewed were the consecutive patients that underwent free tissue transfers of the head and neck by a single surgeon between July2000 and July2008 at the affiliated hospitals of an academic medical center in a large metropolitan area. Data were reviewed for pre-operative variables (prior irradiation and chemotherapy, ASA score); free tissue transfer characteristics (flap area, harvest and ischemia times); intra-operative variables (estimated blood loss, fluid administration); post-operative variables (medical/surgical complications, intensive care unit [ICU] and total hospital days); and post-treatment mortality. Results: There were 57, 47 and 61 patients comprising the study populations at the private hospital, public hospital and VA hospital, respectively. Statistically significant factors were: age (p<0.0001), intraoperative fluid administration (p=0.008), ICU days (p<0.0001), total hospital days (p=0.0002), and surgical complications (p=0.002). Four (7%), five (11%) and four patients (7%), respectively, experienced total flap loss requiring an additional flap (p=ns). Prior irradiation and/or chemotherapy, ASA score, and free tissue transfer characteristics did not differ significantly among hospital populations. There were no significant differences in posttreatment Kaplan-Meier survival curves (p=0.299). Conclusion: Free tissue transfer can and should be performed in different hospital populations with comparably high rates of success. Although the VA patients had more surgical complications postoperatively, this did not significantly affect postoperative survival when compared to the two other hospital populations. ICU and total hospital stays should be safely reduced in the public and VA hospitals, which may reduce hospital costs at these institutions. Outcomes Comparison of Free Tissue Transfers of the Head and Neck in Three Different Hospital Populations Larry L Myers, MD Department of Otolaryngology-Head and Neck Surgery The University of Texas Southwestern Medical Center Dallas, TX