IMPORTANCE Limited evidence is available to guide drain removal after selective lateral neck dissection (SLND). Patients may have drains left in longer than necessary, leading to patient discomfort, longer hospitalizations, and increased costs.OBJECTIVE To compare 2 output volume thresholds for drain removal after SLND. DESIGN, SETTING, AND PARTICIPANTSThis single-blind randomized clinical trial included a consecutive sample of all adult patients undergoing unilateral or bilateral SLND of levels I to III, I to IV, II to III, or II to IV from March 1, 2015, to December 1, 2016, at a tertiary academic medical center. Eligible patients had at least 30 days of follow-up. Patients undergoing a parotidectomy, a level V lymphadenectomy, or an SLND that communicated with the upper aerodigestive tract or who had a suspected chylous fistula on the first postoperative day were excluded from enrollment. Sixty-five patients were offered enrollment and 12 refused. Fifty-three patients who underwent 67 SLNDs were included in the final analysis, with no patients lost to follow-up. Analysis was based on intention to treat.INTERVENTIONS On the first postoperative day, patients were randomized to either a drain removal threshold of less than 30 mL or less than 100 mL during a 24-hour period.MAIN OUTCOMES AND MEASURES Duration of drain use, hospital length of stay, and wound complications for both groups.RESULTS Among the 53 patients with 67 SLNDs included in the analysis (45 men [85%] and 8 women [15%]; mean age, 58.5 years [95% CI, 53.2-64.5 years]), 32 SLNDs were randomized to the 100-mL group and 35 were randomized to the 30-mL group. No meaningful differences in preoperative characteristics were noted between groups. Two seromas occurred in the 100-mL group (2 of 32 [6.3%; 95% CI, 0%-13.5%]) and in the 30-mL group (2 of 35 [5.7%; 95% CI, 0%-14.6%]). No hematomas, chylous fistulas, or wound infections occurred. The 100-mL group had a 1.87-day reduction in mean hospital length of stay (95% CI, 0.66-3.10 days). CONCLUSIONS AND RELEVANCEA volume threshold for drain removal of 100 mL during a 24-hour period after SLNDs appears to be safe and may significantly reduce duration of drain use and hospital length of stay. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03113526

To evaluate the role of hospital setting (standalone cancer center vs. large multidisciplinary hospital) on free tissue transfer (FTT) outcomes for head and neck reconstruction. Medical records were reviewed of 180 consecutive patients undergoing FTT for head and neck reconstruction. Operations occurred at either a standalone academic cancer center ( = 101) or a large multidisciplinary academic medical center ( = 79) by the same surgeons. Patient outcomes, operative comparisons, and hospital costs were compared between the hospital settings. The cancer center group had higher mean age (65.2 vs. 60 years; = 0.009) and a shorter mean operative time (12.3 vs. 13.2 hours; = 0.034). Postoperatively, the cancer center group had a significantly shorter average ICU stay (3.45 vs. 4.41 days; < 0.001). There were no significant differences in medical or surgical complications between the groups. Having surgery at the cancer center was the only significant independent predictor of a reduced ICU stay on multivariate analysis (Coef 0.73; < 0.020). Subgroup analysis, including only patients with cancer of the aerodigestive tract, demonstrated further reduction in ICU stay for the cancer center group (3.85 vs. 5.1 days; < 0.001). A cost analysis demonstrated that the reduction in ICU saved $223,816 for the cancer center group. Standalone subspecialty cancer centers are safe and appropriate settings for FTT. We found both reduced operative time and ICU length of stay, both of which contributed to lower overall costs. These findings challenge the concept that FTT requires a large multidisciplinary hospital. 4.