title: Resource utilization and patient morbidity in head and neck reconstruction.
abstract: Many papers have addressed the technical aspects of free tissue transfer in head and neck cancer patients. However, there has not been a critical assessment of the impact of free tissue transfer on resource utilization and patient morbidity compared with pedicle flap reconstructions. Two cohorts of patients derived from 245 consecutive reconstructions were tightly matched by age, site, stage, and histology, yielding 44 patient pairs differing in method of reconstruction. Patients undergoing free flap reconstruction spent more time in the operating room than those reconstructed with pedicled flaps (993 min vs. 777 min, P < 0.0001). The group with free flap reconstruction spent fewer days in the surgical intensive care unit and hospital (2 days vs. 2.5 days; 18.5 days vs. 22.6 days). This difference is attributed to the paucity of postoperative complications in the group with free flap reconstruction (fistula formation 4.5% vs. 21%, P < 0.04). These data indicate that the continued use of sophisticated reconstructive techniques in head and neck cancer patients is economically sound as assessed by patient morbidity and resource utilization.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, 52242, U.S.A.
authors.forename: M R
authors.initials: MR
authors.lastname: Brown
authors.forename: T M
authors.initials: TM
authors.lastname: McCulloch
authors.forename: G F
authors.initials: GF
authors.lastname: Funk
authors.forename: S M
authors.initials: SM
authors.lastname: Graham
authors.forename: H T
authors.initials: HT
authors.lastname: Hoffman
mesh_terms: D003422:Critical Care / Q000706:statistics & numerical data; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000379:methods*