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Intensive Care Unit Versus Ward Management After Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation.

Abstract：

BACKGROUND:Whether postoperative care in the intensive care unit (ICU) is a necessity for patients undergoing head and neck free flap reconstruction remains debatable. In August 2012, our institute initiated a policy to care for these patients in the ICU, opposed to the previous policy of care in the ward. Thus, we used this opportunity to compare outcomes between these 2 care approaches. PATIENTS AND METHODS:Patients with oral cancer who underwent cancer ablation and immediate anterolateral thigh flap reconstruction from August 2010 to July 2014 were included in this retrospective study. Patients who simultaneously received an additional flap reconstruction were excluded. Before August 2012, these patients were routinely transferred to the ward for postoperative care (ward group, n = 179). Since August 2012, these patients have routinely been transferred to the ICU for postoperative care (ICU group, n = 138). RESULTS:Both groups had comparable flap outcomes in terms of the rates of take-back, successful salvage, flap survival, and flap complication. Compared with the ward group, the ICU group showed an increased use of postoperative sedation (26.7% vs 6.8%, P = 0.000), a correspondingly longer use of mechanical ventilation (3.0 ± 2.7 days vs 0.4 ± 1.4 days, P = 0.000), and a higher incidence of sepsis (3.6% vs 0%, P = 0.015). CONCLUSIONS:Postoperative care of patients who have undergone anterolateral thigh flap reconstruction after oral cancer ablation in the ward or ICU resulted in comparable flap outcomes. Risks and benefits between ward and ICU postoperative management in terms of nursing workloads, monitoring facilities, use of sedation and mechanical ventilation, and potential for sepsis should be taken into consideration when defining postoperative care settings in these patients.

journal_name

Ann Plast Surg

journal_title

Annals of plastic surgery

authors

Chen WC,Hung KS,Chen SH,Shieh SJ,Lee JW,Hsiao JR,Lee YC

doi

10.1097/SAP.0000000000001301

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

S11-S14

issue

2S Suppl 1

eissn

0148-7043

issn

1536-3708

journal_volume

pub_type

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Intensive Care Unit Versus Ward Management After Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation.