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Original Investigation |

Disposition of Elderly Patients After Head and Neck Reconstruction

Jeanne L. Hatcher, MD1; Elizabeth Bradford Bell, MD2; J. Dale Browne, MD3; Joshua D. Waltonen, MD3
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio
2Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
3Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1236-1241. doi:10.1001/jamaoto.2013.5054.
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Importance  A patient’s needs at discharge, particularly the need for nursing facility placement, may affect hospital length of stay and health care costs. The association between age and disposition after microvascular reconstruction of the head and neck has yet to be reported in the literature.

Objective  To determine whether elderly patients are more likely to be discharged to a nursing or other care facility as opposed to returning home after microvascular reconstruction of the head and neck.

Design, Setting, and Participants  From January 1, 2001, through December 31, 2010, patients undergoing microvascular reconstruction at an academic medical center were identified and their medical records systematically reviewed. During the study period, 457 patients were identified by Current Procedural Terminology codes for microvascular free tissue transfer for a head and neck defect regardless of cause. Seven patients were excluded for inadequate data on the postoperative disposition or American Society of Anesthesiologists (ASA) score. A total of 450 were included for analysis.

Main Outcomes and Measures  Demographic and surgical data were collected, including the patient age, ASA score, and postoperative length of stay. These variables were then compared between groups of patients discharged to different posthospitalization care facilities.

Results  The mean age of participants was 59.1 years. Most patients (n = 386 [85.8%]) were discharged home with or without home health services. The mean age of those discharged home was 57.5 years; discharge to home was the reference for comparison and odds ratio (OR) calculation. For those discharged to a skilled nursing facility, mean age was 67.1 years (OR, 1.055; P < .001). Mean age of those discharged to a long-term acute care facility was 71.5 years (OR, 1.092; P = .002). Length of stay also affected the disposition to a skilled nursing facility (OR, 1.098), as did the ASA score (OR, 2.988).

Conclusions and Relevance  Elderly patients are less likely to be discharged home after free flap reconstruction. Age, ASA score, and length of stay are independent factors for discharge to a nursing or other care facility.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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