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Original Investigation |

Factors Associated With Hospital Length of Stay Following Fibular Free-Tissue Reconstruction of Head and Neck Defects Assessment Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Criteria

Laura J. White, MD1; Hongzheng Zhang, PhD, MPH1; Kaitlyn F. Strickland, BS1; Mark W. El-Deiry, MD1; Mihir R. Patel, MD1; J. Tradnor Wadsworth, MD1; Amy Y. Chen, MD, MPH1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Emory University Hospital Midtown, Atlanta, Georgia
JAMA Otolaryngol Head Neck Surg. 2015;141(12):1052-1058. doi:10.1001/jamaoto.2015.0756.
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Importance  Cost containment is at the forefront of responsible health care delivery. One way to decrease costs is to decrease hospital length of stay (LOS). Data are lacking on factors contributing to LOS in patients with head and neck cancer (HNC) undergoing fibular free-tissue reconstruction (FFTR) of head and neck defects.

Objective  To identify factors contributing to increased LOS following FFTR of head and neck defects in patients with HNC using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) methodology.

Design  Retrospective medical record review, with reference to the ACS NSQIP form, of 30 consecutive patients with HNC undergoing FFTR of head and neck defects in a single tertiary academic institution from July 2013 through June 2014. Data were collected on demographic and tumor characteristics, preoperative risk factors, operative variables, and postoperative adverse events.

Main Outcomes and Measures  Factors associated with increased hospital LOS.

Results  Median LOS was 10 days (range, 8-31 days), and patients were divided into 2 groups (LOS, ≤10 days [n = 16]; and LOS, >10 days [n = 14]). There were no significant differences in demographics, tumor characteristics, or preoperative medical comorbidities between the 2 groups. Univariate analysis demonstrated that operative time, ventilator dependence, wound event, and altered mental status were associated with longer LOS. Multivariate analysis revealed significant association with LOS greater than 10 days for operative time of longer than 11 hours (odds ratio [OR], 7.26; 95% CI, 1.12-47.29; P = .04) and ventilator dependence for more than 48 hours postoperatively (OR, 12.05; 95% CI, 1.06-137.43; P = .045).

Conclusions and Relevance  Evaluated by the ACS NSQIP criteria, FFTR of head and neck defects in patients with HNC was associated with LOS longer than 10 days for procedures lasting longer than 11 hours and for patients who are ventilator dependent for more than 48 hours.

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