Comparing postoperative outcomes after free flap surgery in a specialty step‐down unit vs nonspecialty intensive care unit

Abstract

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).

The Optimal Length of Stay after Microvascular Breast Reconstruction: A Cost-Utility Analysis

“…Indeed, at our institution, microvascular breast reconstruction patients are never admitted to the intensive care unit for the sole purpose of flap monitoring. A number of retrospective studies [32][33][34] and a prospective randomized trial 35 identified that intensive care unit care was associated with equivalent outcomes compared to non-intensive care unit care and that a significant cost savings was realized for flap patients admitted to lower acuity settings. In fact, one study found that the cost of 3 days of intensive care unit care averaged $4449 per day-71 percent more than the daily cost of the standard floor-bed in our analysis.…”

Postoperative care in ICU versus non-ICU after head and neck free-flap surgery: a systematic review and meta-analysis

“…Cervenka et al 17 reported no significant difference between ICU and non-ICU nursing regarding THC. Yang et al 20 stated that THC is about 35% higer in the patients admitted to ICU. Panwar et al 11 and Yalamanchi et al 22 reported a statistically significant difference between ICU and non-ICU caring p<0.001 and 0.00054, respectively.…”

“…However, according to the existing literature, ICU care fee reported to be accounted for about 35% of the total hospital cost. 20 Therefore, admission to non-ICU care could reduce the high cost of ICU services and facilitates the management of available resources.…”

“…The incidence of pneumonia was reported in four studies [17][18][19][20] (6.87% in ICU and 2.45% in non-ICU) with a total of 1203 patients. There was a statistically significant 3).…”

Daily Load Leveling in Surgical Critical Care—The Tip of the Utilization Iceberg

“…5 Adherence to data-driven ICU admission and discharge criteria may reduce unindicated utilization by patients with low preoperative risk scores. Caring for select patients in step-down units rather than ICU beds, such as those undergoing free-flap reconstructions 6 or those requiring insulin infusions, 7 may also reduce bottlenecks for patient flow without compromising outcomes.…”