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.

Head and Neck Surgery

Preoperative Care Clinic Improves Survival for Patients Undergoing Free-Flap Reconstruction

Sunday, October 1, 2023
4:03 PM - 4:09 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Randall J. Harley, MD, MS

    Medical Resident
    University of Pennsylvania
    Philadelphia, PA, United States

    • Co-Author(s)

  • TC

    Tracy Z. Cheng, MD, MHS

    Resident
    University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

  • Soukaina Eljamri, BA

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, PA, United States

  • Preetha S. Velu, BA

    Medical Student
    Boston University Chobanian and Avedisian School of Medicine
    Boston, MA, United States

    • Senior Author(s)

  • SK

    Seungwon Kim, MD

    Associate Professor - Advanced Oncologic Head and Neck Surgery
    University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

Introduction: While microvascular free tissue transfer has increasingly become the preferred reconstruction method for large head and neck cancer defects, these lengthy procedures can lead to complications and extended hospital admissions for patients with multiple comorbidities. This study aims to evaluate whether preoperative management of comorbid health conditions in a preoperative care clinic can improve post-operative outcomes for patients undergoing microvascular free-flap procedures.

Methods: This is a retrospective analysis from a single tertiary academic institution between 2011 and 2021. Adult patients who underwent free-flap reconstruction after head and neck cancer resection were included in this study. Patients who attended a preoperative care clinic were compared with patients who received standard of care. Comorbid health conditions were measured using the Charlson Comorbidity Index (CCI) excluding solid tumors. Primary outcomes were length of hospital stay (LOS), days in ICU, days on ventilator, hospital free days, and overall survival (OS). Interaction models were specified to evaluate the impact of preoperative care based on number of comorbid health conditions.

Results: Of the 148 patients included, 83 attended a preoperative care clinic and 65 received standard care (Age, mean 62.1 [SD 10.8]; Male, 100 [67.6%]; CCI >3, 43 [29.1%]). Patients with CCI >3 who attended a preoperative care clinic had a significant reduction in length of hospital stay (Coefficient [β] -7.7, 95% Confidence Interval [95% CI], -14.3 to -0.1), days in ICU (β, -6.3; 95% CI, -9.2 to -3.5 ), and days on ventilator (β, -4.8; 95% CI, -6.8 to -2.7). Further, we found that patients with CCI >3 who attended the preoperative care clinic had a greater number of hospital free days in the first 90 days following surgery (β, 18.2; 95% CI, 7.7 to 28.7), as well as a five-fold improvement in OS (Hazard ratio, 0.18; 95% CI, 0.04 to 0.9).

Conclusions: Preoperative optimization of comorbidities can reduce hospital stay and improve overall survival among patients with comorbid health conditions undergoing microvascular free-flap procedures.