title: Study of the length of hospital stay for free flap reconstruction of oral and pharyngeal cancer in the context of the new French casemix-based funding.
abstract: The French national health insurance reimbursement system has recently changed from a global hospital funding system to casemix-based funding. The authors studied the factors likely to influence the length of hospital stay for free flap reconstructions after surgery for cancers of the oral cavity or pharynx. Data concerning 207 oral cavity or pharynx free flap reconstructions were extracted from a prospective registration. Lengths of hospital stay were compared by an analysis of variance F test or a nonparametric Kruskal-Wallis test, and transfusion rates were compared by Chi-square test or Fisher's exact test, as appropriate. The median length of hospital stay was 24 days (range: 7-145 days). Length of hospital stay was significantly longer according to the type of flap (p<0.005), in N2-N3 patients (p<0.02), a PINI score more than 10, a 3-4 American Society of Anesthesiologists (ASA) score, the presence of a tracheotomy and in patients requiring transfusion (p<0.0001). As the nodal status, the American Society of Anesthesiologists (ASA) score of the patient, the need of tracheotomy and the type of flap cannot be corrected, the management of preoperative haemoglobin and nutritional status are the sole factors which can improve the length of hospital stay. In the context of the new casemix-based funding, this study raises the problem of harvesting of the fibula flap, management of preoperative haemoglobin and nutritional status.
authors.affiliation: Head and Neck Oncologic Surgery Unit, Institut Curie, 26 rue d'Ulm, 75005 Paris, France. angelique.girod@curie.net
authors.forename: Angélique
authors.initials: A
authors.lastname: Girod
authors.forename: Antonio
authors.initials: A
authors.lastname: Brancati
authors.forename: Véronique
authors.initials: V
authors.lastname: Mosseri
authors.forename: Irène
authors.initials: I
authors.lastname: Kriegel
authors.forename: Thomas
authors.initials: T
authors.lastname: Jouffroy
authors.forename: José
authors.initials: J
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D003953:Diagnosis-Related Groups; D005260:Female; D005602:France / Q000453:epidemiology; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D013524:Surgical Flaps / Q000191:economics; D016896:Treatment Outcome; D055815:Young Adult