Benefits of Immediate Extubation Following Free Tissue Transfer for Head and Neck Reconstruction

Abstract

Background Immediate postprocedure extubation (cessation of mechanical ventilation) after free tissue transfer for head and neck reconstruction may improve outcomes, reduce intensive care unit and hospital length of stay, and reduce overall cost compared with delayed extubation in the intensive care unit.

Methods Medical records of 180 consecutive patients undergoing free tissue transfer for head and neck reconstruction were reviewed. Patients immediately extubated in the operating room (immediate group, N = 63) were compared with patients who were extubated in the intensive care unit (delayed group, N = 117) by univariate and multivariate analysis.

Results Medical complication rates and intensive care unit length of stay were significantly higher in the delayed extubation group (55.5 vs. 12.7%, p < 0.001, and 4.4 vs. 2.9 days, p < 0.001, respectively). Although the rate of preoperative alcohol use was similar between the two groups, significantly fewer patients underwent treatment for alcohol withdrawal or agitation in the immediate extubation group (3.2 vs. 27.4%, p = 0.001). There were no significant differences in surgical complication rates.

Conclusion Immediate postprocedure extubation is associated with shorter intensive care unit length of stay, reduced medical complications, and reduced incidence of treatment for agitation/alcohol withdrawal for patients undergoing free tissue transfer for head and neck reconstruction.

Keywords

head and neck reconstruction - microvascular surgery - postoperative management

Note

This work was presented at the American Society for Reconstructive Microsurgery Annual Meeting, January 24 to 27, 2015, Atlantis Resort, Paradise Island, Bahamas.

• References

• 1 Suh JD, Sercarz JA, Abemayor E , et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2004; 130 (8) 962-966
• 2 Spiegel JH, Polat JK. Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope 2007; 117 (3) 485-490
• 3 Allak A, Nguyen TN, Shonka Jr DC, Reibel JF, Levine PA, Jameson MJ. Immediate postoperative extubation in patients undergoing free tissue transfer. Laryngoscope 2011; 121 (4) 763-768
• 4 Jones NF, Jarrahy R, Song JI, Kaufman MR, Markowitz B. Postoperative medical complications—not microsurgical complications—negatively influence the morbidity, mortality, and true costs after microsurgical reconstruction for head and neck cancer. Plast Reconstr Surg 2007; 119 (7) 2053-2060
• 5 To EW, Tsang WM, Lai EC, Chu MC. Retrospective study on the need of intensive care unit admission after major head and neck surgery. ANZ J Surg 2002; 72 (1) 11-14
• 6 Nkenke E, Vairaktaris E, Stelzle F, Neukam FW, St Pierre M. No reduction in complication rate by stay in the intensive care unit for patients undergoing surgery for head and neck cancer and microvascular reconstruction. Head Neck 2009; 31 (11) 1461-1469
• 7 Clemens MW, Hanson SE, Rao S, Truong A, Liu J, Yu P. Rapid awakening protocol in complex head and neck reconstruction. Head Neck 2015; 37 (4) 464-470
• 8 McVeigh KP, Moore R, James G, Hall T, Barnard N. Advantages of not using the intensive care unit after operations for oropharyngeal cancer: an audit at Worcester Royal Hospital. Br J Oral Maxillofac Surg 2007; 45 (8) 648-651
• 9 Patel RS, McCluskey SA, Goldstein DP , et al. Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck. Head Neck 2010; 32 (10) 1345-1353
• 10 Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med 2010; 38 (1) 65-71
• 11 Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med 2005; 33 (6) 1266-1271