title: Does a Standalone Cancer Center Improve Head and Neck Microsurgical Outcomes?
abstract: ObjectivesTo evaluate the role of hospital setting (standalone cancer center vs. large multidisciplinary hospital) on free tissue transfer (FTT) outcomes for head and neck reconstruction.MethodsMedical records were reviewed of 180 consecutive patients undergoing FTT for head and neck reconstruction. Operations occurred at either a standalone academic cancer center (n= 101) or a large multidisciplinary academic medical center (n= 79) by the same surgeons. Patient outcomes, operative comparisons, and hospital costs were compared between the hospital settings.ResultsThe cancer center group had higher mean age (65.2 vs. 60 years;p= 0.009) and a shorter mean operative time (12.3 vs. 13.2 hours;p= 0.034). Postoperatively, the cancer center group had a significantly shorter average ICU stay (3.45 vs. 4.41 days;p< 0.001). There were no significant differences in medical or surgical complications between the groups. Having surgery at the cancer center was the only significant independent predictor of a reduced ICU stay on multivariate analysis (Coef 0.73;p< 0.020). Subgroup analysis, including only patients with cancer of the aerodigestive tract, demonstrated further reduction in ICU stay for the cancer center group (3.85 vs. 5.1 days;p< 0.001). A cost analysis demonstrated that the reduction in ICU saved $223,816 for the cancer center group.ConclusionStandalone subspecialty cancer centers are safe and appropriate settings for FTT. We found both reduced operative time and ICU length of stay, both of which contributed to lower overall costs. These findings challenge the concept that FTT requires a large multidisciplinary hospital.Level of Evidence4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Tamplen
authors.affiliation: Lean Transformation Office, University of California San Francisco, San Francisco, California.
authors.forename: Jesse
authors.initials: J
authors.lastname: Tamplen
authors.affiliation: George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Torrecillas
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Rahul
authors.initials: R
authors.lastname: Seth
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Santo
authors.initials: S
authors.lastname: Ricceri
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Shirin
authors.initials: S
authors.lastname: Hemmat
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Chase
authors.initials: C
authors.lastname: Heaton
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
authors.forename: William R
authors.initials: WR
authors.lastname: Ryan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California.
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Knott
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities / Q000191:economics / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006769:Hospitals, General / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008866:Microsurgery / Q000191:economics / Q000379:methods; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology