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Background To determine if there was a difference in postoperative outcomes of head and neck free flap reconstruction patients treated in a specialty step‐down unit compared to a nonspecialty intensive care unit (ICU). Methods A retrospective review was performed of all patients who underwent free flap reconstruction for head and neck defects from 2014 to 2017 at Loyola University Medical Center. Patients managed postoperatively in the ICU were compared to patients managed in a specialty step‐down unit. Postoperative outcomes, length of stay, and readmission were compared. Results Three hundred and five patients were included in the study. Patients managed postoperatively in the specialty step‐down unit had comparable rates of postoperative complications and flap failure as ICU patients. Step‐down patients had significantly shorter lengths of stay (Mdn = 5 days, IQR = 5‐7 days) than patients in the ICU (Mdn = 6 days, IQR = 5‐6 days; P < .001).

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