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Head and Neck Surgery

Flap to Floor: Free Flap Comparative Outcomes Outside the ICU

Sunday, October 1, 2023
4:09 PM - 4:15 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Kavita Prasad, BA

    Research Fellow
    Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
    Nashville, TN, United States

    • Co-Author(s)

  • Madelyn N. Stevens, MD

    Head and Neck Fellow
    Medical University of South Carolina
    Charleston, SC, United States

  • Rahul K. Sharma, MD

    Resident Physician
    Vanderbilt University Medical Ctr
    Nashville, TN, United States

  • Michael C. Topf, MD

    Assistant Professor
    Vanderbilt University Medical Center
    Nashville, TN, United States

  • Alexander J. Langerman, MD, SM, FACS

    Associate Professor
    Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
    Nashville, TN, United States

  • KM

    Kyle Mannion, MD

    Associate Professor
    Vanderbilt University Medical Center
    nashville, Tennessee, USA

    • Senior Author(s)

  • Sarah L. Rohde, MD, MMHC

    Associate Professor
    Vanderbilt University Medical Center
    Nashville, TN, United States

Disclosure(s):
Kavita Prasad, BA: No relevant relationships to disclose.
Rahul K. Sharma, MD: No relevant relationships to disclose.
Sarah L. Rohde, MD, MMHC: No relevant relationships to disclose.
Introduction: To optimize efficient use of healthcare resources, there is a trend towards non-intensive care unit (ICU) management of patients. Here we compare post-operative outcomes for patients transferred to a general ward following microvascular free flap (FF) reconstruction of the head and neck.

Methods: This is a retrospective study at a tertiary care center of consecutive patients who underwent FF of the head and neck. In May 2022, a protocol was implemented shifting post-operative FF care out of the ICU (every hour FF monitoring) to a general surgical floor setting (every 4-hour FF monitoring). Outcomes include overall length of stay (LOS), ICU LOS, and post-operative complications in the three months prior to and following this change.

Results: A total of 76 patients were included, 34 in cohort 1 (ICU protocol) and 42 in cohort 2 (non-ICU protocol). There were no significant difference in age, sex or comorbidities. Eighty-eight percent (n=30) of patients in cohort 1 went to the ICU versus 9.5% (n=4) in cohort 2 (p < 0.01). Mean LOS decreased from 8.0 to 7.4 days (p=0.8), and mean ICU LOS decreased from 4.6 to 1.2 days (p < 0.01). There were no significant difference in post-operative complications (8.8% vs. 17.0%, p=0.5), including airway-related complications (15.0% vs. 7.1%, p=0.5), or FF failure rate (5.9% vs 4.5%, p>0.9). Cohort 2 had more ancillary consults (55.0% vs. 38.0%; p=0.2), most often to acute pain, cardiology, and endocrinology. There was an increase in rapid response team calls (nurse-driven safety net for abnormal vitals or mental status) for patients in cohort 2 (17% v 2.9%, p=0.04); four patients required ICU care for airway or cardiac events. The mean percentage of traveler or float nurses was 14.2 (s.d 2.3%) for cohort 1 and 22.8% (s.d. 4.4%) for cohort 2.

Conclusions: Head and neck FF patients can be successfully managed pot-operatively in a non-ICU setting with no increase in post-operative complications, including FF flap failures. Quality assurance data is ongoing. Preliminary data suggests management of patients on a general floor, even impacted by use of traveling nurses, is safe and conserves ICU beds.