title: Intensive care unit versus non-intensive care unit postoperative management of head and neck free flaps: comparative effectiveness and cost comparisons.
abstract: BACKGROUND
  Despite its widespread use, there is no consensus on the postoperative management in patients undergoing free flap reconstructions. We report the largest study comparing flap outcomes, morbidity, and cost in patients with head and neck cancer free flaps who recovered in the intensive care unit (ICU) versus a "specialty floor" setting.
  
  
  METHODS
  This was a retrospective review of patients undergoing free flap surgery for head and neck defects over a 4-year period. Patients before a certain date went to the ICU for immediate postoperative care and after to a non-ICU setting. Postoperative medical and surgical complications and hospital charges were analyzed.
  
  
  RESULTS
  Patients in the ICU group had a longer length of stay (LOS) and incurred greater hospital costs than the patients in the non-ICU setting. There was no difference in the flap failure rate between the 2 groups.
  
  
  CONCLUSIONS
  Consideration should be given to a floor-based postoperative management regimen for this patient population.
authors.affiliation: Department of Head and Neck Surgery/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Hassan
authors.initials: H
authors.lastname: Arshad
authors.forename: Hatice Gulcin
authors.initials: HG
authors.lastname: Ozer
authors.forename: Aaron
authors.initials: A
authors.lastname: Thatcher
authors.forename: Matthew
authors.initials: M
authors.lastname: Old
authors.forename: Enver
authors.initials: E
authors.lastname: Ozer
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.forename: Hosseinali
authors.initials: H
authors.lastname: Jafari
authors.forename: Danette
authors.initials: D
authors.lastname: Birkheimer
authors.forename: Heidi
authors.initials: H
authors.lastname: Basinger
authors.forename: L Arrick
authors.initials: LA
authors.lastname: Forest
authors.forename: David E
authors.initials: DE
authors.lastname: Schuller
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Teknos
mesh_terms: D016063:Blood Loss, Surgical; D005260:Female; D058752:Free Tissue Flaps; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000191:economics* / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011182:Postoperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: ICU; free flap; head and neck; microvascular reconstruction; postoperative management