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J Reconstr Microsurg 2016; 32(07): 533-539
DOI: 10.1055/s-0036-1582262
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Matthew L. Tamplen
1   Department of Otolaryngology—Head and Neck Surgery, University of California San Francisco, San Francisco, California
,
Santo Ricceri
1   Department of Otolaryngology—Head and Neck Surgery, University of California San Francisco, San Francisco, California
2   School of Medicine, University of California San Francisco, San Francisco, California
,
Shirin Hemmat
1   Department of Otolaryngology—Head and Neck Surgery, University of California San Francisco, San Francisco, California
2   School of Medicine, University of California San Francisco, San Francisco, California
,
Rahul Seth
1   Department of Otolaryngology—Head and Neck Surgery, University of California San Francisco, San Francisco, California
,
William R. Ryan
1   Department of Otolaryngology—Head and Neck Surgery, University of California San Francisco, San Francisco, California
,
P. Daniel Knott
1   Department of Otolaryngology—Head and Neck Surgery, University of California San Francisco, San Francisco, California
› Author Affiliations
Further Information

Publication History

12 October 2015

23 February 2016

Publication Date:
25 April 2016 (online)

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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.


 

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