BACKGROUND: Immediate reconstruction of composite head and neck defects using free tissue transfer is an accepted treatment standard. There remains, however, ongoing debate on whether the costs associated with this reconstructive approach merit its selection, especially considering poor patient prognoses and the high cost of care. METHODS: A retrospective review of the last 100 consecutive patients undergoing microsurgical reconstruction for head and neck cancer by the two senior surgeons was performed to determine whether microsurgical complications or postoperative medical complications had the more profound influence on morbidity and mortality outcomes and the true costs of these reconstructions. RESULTS: Two patients required re-exploration of the microsurgical anastomoses, for a re-exploration rate of 2 percent, and one flap failed, for a flap success rate of 99 percent. The major surgical complication rate requiring a second operative procedure was 6 percent. Sixteen percent had minor surgical complications related to the donor site. Major medical complications, defined as a significant risk to the patient's life, occurred in 5 percent of the patients, but there was a 37 percent incidence of "minor" medical complications primarily caused by pulmonary problems and alcohol withdrawal. Postsurgical complications almost doubled the average hospital stay from 13.5 days for those patients without complications to 24 days for patients with complications. Thirty-six percent of the true cost of microsurgical reconstruction of head and neck cancer was due to the intensive care unit and hospital room costs, and 24 percent was due to operating room costs. Postsurgical complications resulted in a 70.7 percent increase in true costs, reflecting a prolonged stay in the intensive care unit and not an increase in operating room costs or regular hospital room costs. CONCLUSION: Postoperative medical complications in these elderly, debilitated patients related to pulmonary problems and alcohol withdrawal were statistically far more important in negatively affecting the outcomes and true costs of microsurgical reconstruction.
BACKGROUND: Immediate reconstruction of composite head and neck defects using free tissue transfer is an accepted treatment standard. There remains, however, ongoing debate on whether the costs associated with this reconstructive approach merit its selection, especially considering poor patient prognoses and the high cost of care. METHODS: A retrospective review of the last 100 consecutive patients undergoing microsurgical reconstruction for head and neck cancer by the two senior surgeons was performed to determine whether microsurgical complications or postoperative medical complications had the more profound influence on morbidity and mortality outcomes and the true costs of these reconstructions. RESULTS: Two patients required re-exploration of the microsurgical anastomoses, for a re-exploration rate of 2 percent, and one flap failed, for a flap success rate of 99 percent. The major surgical complication rate requiring a second operative procedure was 6 percent. Sixteen percent had minor surgical complications related to the donor site. Major medical complications, defined as a significant risk to the patient's life, occurred in 5 percent of the patients, but there was a 37 percent incidence of "minor" medical complications primarily caused by pulmonary problems and alcohol withdrawal. Postsurgical complications almost doubled the average hospital stay from 13.5 days for those patients without complications to 24 days for patients with complications. Thirty-six percent of the true cost of microsurgical reconstruction of head and neck cancer was due to the intensive care unit and hospital room costs, and 24 percent was due to operating room costs. Postsurgical complications resulted in a 70.7 percent increase in true costs, reflecting a prolonged stay in the intensive care unit and not an increase in operating room costs or regular hospital room costs. CONCLUSION: Postoperative medical complications in these elderly, debilitated patients related to pulmonary problems and alcohol withdrawal were statistically far more important in negatively affecting the outcomes and true costs of microsurgical reconstruction.
Authors: John T Nguyen; Yoshitomo Ashitate; Ian A Buchanan; Ahmed M S Ibrahim; Sylvain Gioux; Priti P Patel; John V Frangioni; Bernard T Lee Journal: J Surg Res Date: 2012-05-24 Impact factor: 2.192
Authors: Thomas Mücke; Janett Koschinski; Stefan Wagenpfeil; Klaus-Dietrich Wolff; Anastasios Kanatas; David A Mitchell; Herbert Deppe; Marco R Kesting Journal: J Cancer Res Clin Oncol Date: 2011-12-06 Impact factor: 4.553
Authors: Rachel Campbell Hooper; Karina A Hernandez; Tatiana Boyko; Alice Harper; Jeremiah Joyce; Alyssa R Golas; Jason A Spector Journal: Tissue Eng Part A Date: 2014-05-19 Impact factor: 3.845
Authors: Jeanne L Hatcher; Katherine R Sterba; Janet A Tooze; Terry A Day; Matthew J Carpenter; Anthony J Alberg; Christopher A Sullivan; Nora C Fitzgerald; Kathryn E Weaver Journal: Head Neck Date: 2015-05-17 Impact factor: 3.147
Authors: Eric Adjei Boakye; Nosayaba Osazuwa-Peters; Betty Chen; Miao Cai; Betelihem B Tobo; Sai D Challapalli; Paula Buchanan; Jay F Piccirillo Journal: JAMA Otolaryngol Head Neck Surg Date: 2020-05-01 Impact factor: 6.223