Clin Exp Otorhinolaryngol.  2019 Aug;12(3):308-316. 10.21053/ceo.2018.01235.

Clinical Outcomes of a 14-Day In-Hospital Stay Program in Patients Undergoing Head and Neck Cancer Surgery With Free Flap Reconstruction Under the National Health Insurance System

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hansin.jeong@samsung.com

Abstract


OBJECTIVES
Length of in-hospital stay (LOS) is often regarded as a surrogate marker of efficiency in medical care. A shorter stay can redistribute medical resources to more patients if patient outcomes would not be worsened. However, the adequate LOS remains largely understudied for a complex head and neck cancer (HNC) surgery and free flap reconstruction.
METHODS
Active management of LOS (14-day LOS program) included detailed preoperative surgical planning, intensive wound care, postoperative early ambulation and positive psychological encouragement. It was applied to 43 patients undergoing HNC surgery and free flap reconstruction. Outcomes such as noninferior oncological results, rates of timely adjuvant treatments and complications were compared with those of 125 patients without active management of LOS. In addition, the medical costs of shortened LOS were compared with those of the control group. Cases undergoing HNC surgery as a salvage treatment were excluded from both groups for analyses.
RESULTS
Active management of LOS resulted in less in-hospital period compared to the control group (15.0 vs. 21.0 days, P=0.001), and reduced medical costs significantly. Incidence of postoperative complications was comparable between the two groups. Oncological outcomes did not differ significantly according to LOS. In all patients in both groups, initial high T status (T3-4) and occurrence of postoperative complications were independent risk factors for long LOS (>30 days).
CONCLUSION
In patients undergoing HNC surgery with free flap reconstruction as an initial treatment, a 14-day LOS could be safe in terms of comparable oncological outcomes and postoperative complications. To achieve this goal safely, careful management for T3-4 tumors and prevention of postoperative complications seem to be necessary.

Keyword

Head and Neck Neoplasms; Reconstructive Surgical Procedures; Length of Stay; Outcomes

MeSH Terms

Biomarkers
Early Ambulation
Free Tissue Flaps*
Head and Neck Neoplasms*
Head*
Humans
Incidence
Length of Stay
National Health Programs*
Postoperative Care
Postoperative Complications
Reconstructive Surgical Procedures
Risk Factors
Salvage Therapy
Wounds and Injuries
Biomarkers

Figure

  • Fig. 1. (A) Schematic illustration showing a 14-day length of in-hospital stay (LOS) program for head and neck cancer patients with ablative surgery and on-site free flap reconstruction. (B) Average LOS duration (day) for groups with and without active management of LOS. Group 1, patients without active management of LOS; Group 2, patients under a 14-day LOS program. Values are presented as median (interquartile range). P<0.001.


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