Skip to main content
AAO-HNSF 2023 Annual Meeting & OTO Experience Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back
Rate ePoster

Head and Neck Surgery

(071) Burden of Free Flap Monitoring on Intensive Care Unit Staff

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • DAVID Strum, MD

    Resident Physician
    NYU Grossman School of Medicine Department of Otolaryngology Head and Neck Surgery
    New York, New York, United States

    • Co-Author(s)

  • MC

    Michael Chow, MD

    Department of Otolaryngology, NYU Langone Health, USA

  • AS

    Arman Saeedi, BS, MPH

    Department of Otolaryngology – Head and Neck Surgery, New York University Grossman School of Medicine, USA

    • Senior Author(s)

  • PS

    Philip Sommer, MD

    NYU Grossman School of Medicine Department of Anesthesia, Perioperative Care, and Pain Medicine, USA

  • Babak Givi, MD, MHPE

    Associate Attending
    Memorial Sloan Kettering Cancer Center
    New York, NY, United States

  • Lindsey Moses, MD

    Clinical Assistant Professor of Otolaryngology-Head and Neck Surgery
    NYU Grossman School of Medicine Department of Otolaryngology Head and Neck Surgery
    Brooklyn, New York, United States

Disclosure(s):
DAVID Strum, MD: No relevant relationships to disclose.
Lindsey Moses, MD: No relevant relationships to disclose.


Introduction: Microvascular free flaps are commonly used to reconstruct oncologic defects in the head and neck. Despite high success rates, monitoring protocols for flap failure are rigorous and can be burdensome for staff in the immediate post operative period. We surveyed intensive care unit (ICU) staff to estimate the nursing time and effort required for flap monitoring and also evaluated the frequency of flap checks needed to prevent a takeback to the operating room.

Methods: A twelve-question survey was distributed to ICU nurses asking about the time and effort associated with free flap monitoring. We reviewed all head and neck free flap patients in the immediate three-year period from 2019-2022 preceding the survey distribution to assess the incidence of return to the operating room for flap salvage in the immediate post operative period.

Results: Twenty-seven ICU nurses completed the survey. The majority (14, 52%) felt that free flap monitoring frequently hampered their ability to care for other patients. Almost all (26, 96%) participants stated inadequate time as a primary barrier to effective monitoring. Two hundred patients underwent free flap reconstruction during the study period. Only nine out of two hundred (4.5%) of patients returned to the OR within the first 48 hours for flap compromise, and all were successfully salvaged. In our population, a monitoring protocol of hourly checks in the first 48 hours requires approximately 1,066 flap checks to capture a single critical event.

Conclusions: Frequent flap monitoring imposes a significant workload on ICU nurses due to rigorous flap monitoring protocols, while actionable critical events are rarely observed. With rates of burnout and staff attrition at record highs, this data justifies exploring new technologies and routines in free flap monitoring that may reduce the work burden to better care for our staff while maintaining safety and excellent patient outcomes.