Critical Importance of the First Postoperative Days After Head and Neck Free Flap Reconstruction: An Analysis of Timing of Reoperation Using the National Surgical Quality Improvement Program Database. Issue 3 (September 2022)

• Record Type: Journal Article
• Authors: Elmer, Nicholas A.; Baltodano, Pablo A.; Webster, Theresa; Deng, Mengying; Egleston, Brian; Massada, Karen; Kaplunov, Briana; Brebion, Rohan; Araya, Sthefano; Patel, Sameer A.
• Is Part Of: Annals of plastic surgery. Volume 89:Issue 3(2022)
• Page Start: 295
• Page End: 300
• Publication Date: 2022-09
• Subjects: first postoperative day -- free flap reconstruction -- National Surgical Quality Improvement Program -- reoperation; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000003260
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Background: Head and neck free flaps remain associated with considerable rates of take-back and prolonged hospital length of stay. However, there have been no studies on a national level benchmarking the timeline and predictors of head and neck free flap take-back. Methods: Patients undergoing head and neck free flap reconstruction from the American College of Surgeons National Surgical Quality Improvement Program 2012–2019 database were analyzed to determine the rates of take-back. Timing and rates of unplanned head and neck free flap take-backs were stratified by tissue type and postoperative day (POD) over the first month. Weibull survival models were used to compare rates of take-backs among time intervals. Multivariable logistic regression was used to identify the independent predictors of take-back. Results: Three thousand nine hundred six head and neck free flaps were analyzed. The mean daily proportion of patients experiencing take-back during PODs 0 to 1 was 0.95%; this dropped significantly to a mean daily proportion of 0.54% during POD 2 ( P < 0.01). In addition, there were significant drops in take-back when comparing POD 2 (0.54%) to POD 3 (0.26%) and also when comparing POD 4 (0.20%) with PODs 5 to 30 (0.032% per day) ( P < 0.05). The soft tissue and osseous flap populations demonstrated a similar trend in unplanned take-back. Conclusion: This is the first national study to specifically analyze the timing of take-back in the head and neck reconstruction population. These data highlight the importance of flap monitoring during the first 5 PODs, with ERAS pathway optimization aiming for discharge by the end of the first postoperative week.