title: Comparing microvascular outcomes at a large integrated health maintenance organization with flagship centers in the United States.
abstract: OBJECTIVE
  To determine if patients undergoing microvascular reconstructive head and neck surgery (MRHNS) at a large integrated health maintenance organization can expect outcomes similar to some of the best or flagship centers in the United States.
  
  
  METHODS
  Outcomes (flap loss, mortality, length of stay), eligibility (recent consecutive US center experience), high-experience (100 cases), high-volume (26 cases per year), and flagship criteria were prospectively defined. A systematic MEDLINE search identified 17 eligible reports. Independent, blinded medical reviewers identified 5 centers (29%) as flagship centers.
  
  
  METHODS
  The first 116 consecutive patients (average, 39 cases per year) who underwent MRHNS on this service.
  
  
  RESULTS
  All 5 flagship centers are major academic health centers ranked in the top 18 "best head and neck hospitals" in the United States. Flap loss (1.7% vs 4.4% for flagship centers; range, 0.9%-8.8%) and mortality (2.6% vs 2.8% for flagship centers; range, 0.5%-6.3%) rates were not significantly different. Although lengths of stay in flagship centers were similar to each other and the literature (mean, 21.4 days; range, 20.1-22.5 days), our length of stay was significantly shorter (8.8 days, P<.001).
  
  
  CONCLUSIONS
  For high-experience and high-volume centers, patients undergoing MRHNS at a large integrated health maintenance organization can expect morbidity and mortality outcomes similar to flagship centers in the United States, with shorter hospitalizations.
authors.affiliation: Microvascular Reconstructive Head and Neck Surgery Service, Regional Head, Neck, and Skullbase Surgical Oncology Center, Southern California Permanente Medical Group, Los Angeles, USA. edgar.a.lueg@kp.org
authors.forename: Edgar A
authors.initials: EA
authors.lastname: Lueg
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006257:Head / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D006276:Health Facility Size; D006279:Health Maintenance Organizations; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008833:Microcirculation / Q000601:surgery; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013524:Surgical Flaps; D014481:United States; D014656:Vascular Surgical Procedures