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Postoperative medical complications--not microsurgical complications--negatively influence the morbidity, mortality, and true costs after microsurgical reconstruction for head and neck cancer.

Abstract：

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.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Jones NF,Jarrahy R,Song JI,Kaufman MR,Markowitz B

doi

10.1097/01.prs.0000260591.82762.b5

subject

Has Abstract

pub_date

2007-06-01 00:00:00

pages

2053-2060

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-200706000-00012

journal_volume

119

pub_type

杂志文章

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Postoperative medical complications--not microsurgical complications--negatively influence the morbidity, mortality, and true costs after microsurgical reconstruction for head and neck cancer.