Preoperative Care Clinic Improves Survival for Patients Undergoing Free‐Flap Reconstruction

TL;DR

A preoperative care clinic significantly improves hospital outcomes and survival for high-risk head and neck cancer patients undergoing reconstruction.

Contribution

Demonstrates that perioperative care reduces hospital stays and improves survival in patients with comorbidities undergoing head and neck reconstruction.

Findings

Patients with higher comorbidities had shorter hospital and ICU stays with perioperative care.

Perioperative care improved overall survival for patients with significant comorbidities.

No significant reduction in complication rates was observed with perioperative care.

Abstract

This study aims to evaluate whether perioperative care improves postoperative outcomes for head and neck reconstruction patients with preexisting health conditions.

Retrospective cohort study.

Single tertiary academic center between 2013 and 2021.

This study included adult patients who underwent free‐flap reconstruction for head and neck cancer. Patients who received perioperative care were compared with patients who received our institution's standard of care. Comorbid health conditions were measured using the Charlson comorbidity index (CCI) excluding solid tumors. Primary outcomes were major and minor complications, length of hospital stay (LOS), days in intensive care unit (ICU), discharge to acute/subacute facility, hospital‐free days, and overall survival (OS). Interaction models were specified to evaluate the impact of preoperative care with respect to CCI.

Of the 148 patients included, 83 received perioperative care and 65 received institutional standard of care (mean [SD]: age, 62.1 [10.8]; male, 100 [67.6%]; CCI ≥ 4, 43 [29.1%]). Patients with higher CCI who received perioperative care spent fewer days in the hospital (CCI 3: coefficient [β], −5.50; P = .012 and CCI ≥ 4: β, −6.41; P = .022) and ICU (CCI 3: β, −2.90; P = .002 and CCI ≥ 4: β, −6.54; P = .001), gained more hospital‐free days (CCI ≥ 4: β, 17.00; P = .002), and had improved OS (CCI ≥ 4: adjusted hazard ratio [aHR], 0.14; P = .023). Perioperative care was not significantly associated with lower rates of major and minor complications or placement at a facility.

Perioperative care provides a robust benefit for patients with medical comorbidities undergoing head and neck reconstruction, but this effect incrementally decreases for healthier patients.

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