title: Morbidity and cost differences between free flap reconstruction and pedicled flap reconstruction in oral and oropharyngeal cancer: Matched control study.
abstract: BACKGROUND
  To compare morbidity and cost in patients who underwent primary reconstruction with free tissue transfer with those with pectoralis major myocutaneous flap (PMMF) reconstructions after ablation of oral and oropharyngeal squamous cell carcinoma.
  
  
  METHODS
  Over a 6-year period, 36 patients had PMMF reconstructions and 127 patients had a variety of free flap (FRF) reconstructions after oral and oropharyngeal cancer ablation. Correction for confounding patient and disease variables was performed by matching all PMMF patients to a randomly selected cohort of FRF patients for age, sex, International Union Against Cancer-American Joint Committee on Cancer T category, tumour subsite, and radiotherapy status. This resulted in two groups of 32 patients each, with the flap reconstruction being the only variable. The following outcome variables were analyzed: operative time; blood loss; admission length, including intensive care unit and coronary care unit stay; complications; secondary interventions; readmissions; and feeding status. Cumulative costs of nursing care, hospital supplies and charges, surgeon's fees, and anesthesiologist's fees were calculated. Statistical analysis applied the paired Student's t-test and the chi-square test.
  
  
  RESULTS
  Of all morbidity parameters, only operative time was significantly longer for FRF (p < .0001). Analysis of other outcome variables and costs showed no statistically significant differences (p > .05).
  
  
  CONCLUSIONS
  There is no evidence that morbidity and cost differ between the pedicled flap and free tissue transfer reconstruction strategies, other than lengthier operating room time for FRF.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wharton Head and Neck Centre, The Toronto Hospital/Princess Margaret Hospital, University of Toronto, Toronto, Ontario.
authors.forename: Ludwig E
authors.initials: LE
authors.lastname: Smeele
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.forename: Vance
authors.initials: V
authors.lastname: Tsai
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: Peter
authors.initials: P
authors.lastname: Neligan
authors.forename: Dale H
authors.initials: DH
authors.lastname: Brown
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D005260:Female; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome