Thomas WW, et al. - This study was aimed to assess patient and surgical factors associated with length of stay (LOS) and reoperation following surgical procedures for malignant neoplasm of the head and neck involving microvascular free tissue transfer reconstruction. American College of Surgeons National Surgical Quality Improvement Program data suggested that wound class of index operation, subsequent wound-related complications, and long duration of the index operation were primarily associated with increased risk for reoperation and, therefore, prolonged hospitalization. These same factors were also linked with prolonged hospitalization without reoperation.

Methods

• From 2012 to 2014, researchers performed a retrospective review of American College of Surgeons National Surgical Quality Improvement Program data using International Classification of Diseases, Ninth Revision (ICD-9), codes for malignant neoplasms of the head and neck.
• They used multivariable logistic regression modeling to determine the correlation of patient and surgical variables with reoperation and LOS.
• Outcomes from community and academic participant hospitals were included in the national retrospective database (517 member institutions in 2014).
• They measured incidence of reoperation within 30 days of index operation and hospitalization equal to or longer than 13.0 days, which is equal to being in the top quartile for duration of stay.

Results

• Researchers performed a retrospective review of a total of 1,115 cases [370 (33.2) were female] of head and neck malignant neoplasm ablation with microvascular free tissue transfer flap.
• The mean (SD) age was 66.8 (3.9) years.
• Return to the operating room (odds ratio [OR], 4.8; 95% CI, 3.3-6.9), smoking (OR, 2.1; 95% CI, 1.5-3.1), clean-contaminated wound (OR, 2.2; 95% CI, 1.3-4.0), bony flap (OR, 1.8; 95% CI, 1.2-2.8), age (OR, 1.5; 95% CI, 1.2-1.7), and operative time (OR, 1.2; 95% CI, 1.1-1.3) were identified as the predictors of prolonged length of stay.
• For 225 patients (20.2%), reoperation occurred 298 times.
• They observed mean (SD) time to reoperation of 8.0 (7.7) days, with 180 (80%) occurring before discharge from the primary operation.
• For reoperation, neck exploration (37 [12.4%]) or incision and drainage of neck (35 [11.7%]) were the most common indications.