title: Intensive Care Unit Monitoring After Pharyngeal Flap Surgery: Is It Necessary?
abstract: OBJECTIVE
  To assess the incidence of perioperative complications and the utility of intensive care monitoring in patients undergoing posterior pharyngeal flap surgery for velopharyngeal dysfunction (VPD).
  
  
  METHODS
  This study was a retrospective evaluation of patients who underwent posterior pharyngeal flap surgery for treatment of VPD and an assessment of the incidence of perioperative complications. Descriptive statistics were computed.
  
  
  RESULTS
  Over an 18-year period, 145 patients underwent pharyngeal flap surgery for VPD; 133 (91.7%) had complete data and were included as subjects. Mean patient age was 9.4 ± 7.4 years; 50.4% were female. One hundred twenty-six patients (94.7%) had a history of cleft palate. Thirty-four patients (25.5%) had asthma or obstructive sleep apnea. Eighty-three patients (62.4%) were admitted to the intensive care unit (ICU) for postoperative monitoring. The average length of hospital stay was 1.9 ± 0.9 days (range, 1 to 5 days). There were no incidents of serious postoperative complications, including death, bleeding, flap dehiscence or loss, or airway compromise requiring reintubation. Two patients (1.5%) had perioperative complications related to respiratory issues, one of whom required readmission to the ICU (0.8%). There were no differences in complications between those who were routinely admitted to the ICU and those who went directly to the floor (P = 1.00). There was no association between respiratory comorbidities and complications (P = .06).
  
  
  CONCLUSIONS
  The perioperative complication rate for posterior pharyngeal flap surgery is low (<2%). Routine ICU admission for monitoring is not necessary.
authors.affiliation: Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Sashank
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Instructor, Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital; Acting Instructor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry; Acting Instructor, Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Susarla
authors.affiliation: Resident, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles, CA.
authors.forename: Nance
authors.initials: N
authors.lastname: Yuan
authors.affiliation: Student, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Gurjot
authors.initials: G
authors.lastname: Walia
authors.affiliation: Resident, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Rochlin
authors.affiliation: Associate Professor, Department of Plastic and Reconstructive Surgery, Johns Hopkins Children's Center, Baltimore, MD. Electronic address: rredett@jhmi.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Redett
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008991:Monitoring, Physiologic; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D010614:Pharynx / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D014681:Velopharyngeal Insufficiency / Q000601:surgery*; D055815:Young Adult