Resident LSUHSC Baton Rouge, Louisiana, United States
Disclosure(s):
Ashley R. Kraft, MD: No relevant relationships to disclose.
Introduction: Patients undergoing HNS with free flap reconstruction require intensive postoperative care, and as such these surgeries are associated with significantly longer hospital stays and need for discharge to a postacute care facilities, or nonhome discharge (NHD), compared to other otolaryngologic surgeries. We seek to determine the predictors of NHD following major HNS with free tissue transfer in baseline home-dwelling patients.
Methods: Following IRB approval of participating institutions, a retrospective review of prospectively collected patient data was completed. Patients undergoing HNS with free flap reconstruction between January 2008 and May 2019 were included and divided into two cohorts: discharges to home and nonhome discharges. The primary outcome measure was discharge destination. Fisher’s Exact Test with simulated p-values and t-tests were used to determine predictive factors for NHD.
Results: Overall 872 cases were included: 157 (18%) required NHD. Significant preoperative predictors for NHD on multivariable analysis included advanced age (68.4 ± 14.5 vs 60.5 ± 13.6 years, P < 0.001) and a history of cardiac disease (27% vs 19%, P = 0.030). NHD was associated with more major postoperative complications including cardiac and pulmonary complications (P = < 0.001), stroke (P = < 0.001), wound dehiscence (P = 0.024), as well as alcohol withdrawal (P = 0.028).
Conclusions: Discharge to NHD following free flap reconstruction of the head and neck can be predicted using preoperative factors. Predictors in our patient cohort of NHD included advanced age and history of cardiac disease. NHD were more likely to suffer postoperative cardiac and pulmonary complications, stroke, wound complications, and alcohol withdrawal. Identifying patients at high risk for NHD may allow for more effective counseling to patients on discharge expectations and allow the surgical team to adequately prepare with social work to expedite referral to rehab or SNFs to avoid unnecessarily long hospital stays and the complications associated with prolonged stays.
