Admission patterns and outcomes of postoperative oral cavity and oropharyngeal cancer patients admitted to critical care in the UK: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database


      Surgery for head and neck malignancy may be complex with postoperative admission to critical care units (CCUs) often required. There are, however, increasing demands on this resource. We examined a national intensive care database to assess patterns of admission and outcomes for patients following surgery for malignancies of the oral cavity and oropharynx. An analysis was performed of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database. Data were extracted on case mix and outcomes for patients coded as ‘malignant neoplasm of the oropharynx requiring surgery’ admitted to critical care between 2010 and 2019. Data included admission numbers, demographics, comorbidities, physiology scores, and outcomes including length of stay and mortality. There were 9,843 admissions for patients with malignancies of the oral cavity and oropharynx from 156 CCUs over the ten-year period. Admissions increased from 486 in 2010 to 1,381 in 2019. These admissions accounted for 0.42% of overall admissions in 2010 and 0.78% in 2019. The median age of patients was 63 years and 63.5% were male. The median length of stay in critical care was 38 hours (Interquartile range (IQR) 20.4-64.3 hours). The median length of total hospital stay was 15 days (IQR 10-23 days). Mortality in critical care was low (0.7%). Admissions to CCUs following surgery for malignancies of the oral cavity and oropharynx have increased over the last decade but remain low overall. With increasing demand for this resource, ongoing monitoring of utilisation is important.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Head and neck cancer statistics. Cancer Research UK. Available from URL: (last accessed 16 May 2022).

        • Homer J.J.
        • Fardy M.J.
        Surgery in head and neck cancer: United Kingdom national multidisciplinary guidelines.
        J Laryngol Otol. 2016; 130: S68-S70
        • Panuganti B.A.
        • Weissbrod P.A.
        • Somal J.
        Critical care and postoperative management of the head and neck patient.
        Otolaryngol Clin North Am. 2019; 52: 1141-1156
        • Cameron M.
        • Corner A.
        • Diba A.
        • et al.
        Development of a tracheostomy scoring system to guide airway management after major head and neck surgery.
        Int J Oral Maxillofac Surg. 2009; 38: 846-849
        • Harrison D.A.
        • Brady A.R.
        • Rowan K.
        Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the intensive care national audit & research centre case mix programme database.
        Crit Care. 2004; 8: R99-R
        • Ferrando-Vivas P.
        • Jones A.
        • Rowan K.M.
        • et al.
        Development and validation of the new ICNARC model for prediction of acute hospital mortality in adult critical care.
        J Crit Care. 2017; 38: 335-339
        • Garantziotis S.
        • Kyrmizakis D.E.
        • Liolios A.D.
        Critical of the head and neck patient.
        Crit Care Clin. 2003; 19: 73-90
        • Abu Al-Saad N.
        • Skedgel C.
        • Nortje J.
        Principles of resource allocation in critical care.
        BJA Educ. 2017; 17: 390-395
        • Richards-Belle A.
        • Orzechowska I.
        • Gould D.W.
        • et al.
        COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland.
        Intensive Care Med. 2020; 46: 2035-2047
        • Shaw R.
        COVIDSurg Collaborative. UK head and neck cancer surgical capacity during the second wave of the COVID-19 pandemic: Have we learned the lessons? COVIDSurg collaborative.
        Clin Otolaryngol. 2021; 46: 729-735
        • Harrison D.A.
        • D’Amico G.
        • Singer M.
        Case mix, outcome, and activity for admissions to UK critical care units with severe acute pancreatitis: a secondary analysis of the ICNARC case mix programme database.
        Crit Care. 2007; 11: S1
        • Damian M.S.
        • Ben-Shlomo Y.
        • Howard R.
        • et al.
        Admission patterns and survival from status epilepticus in critical care in the UK: an analysis of the intensive care national audit and research centre case mix programme database.
        Eur J Neurol. 2020; 27: 57-64
        • McPhail M.J.
        • Parrott F.
        • Wendon J.A.
        • et al.
        Incidence and outcomes for patients with cirrhosis admitted to United Kingdom critical care units.
        Crit Care Med. 2018; 46: 705-712
        • Park D.P.
        • Welch C.A.
        • Harrison D.A.
        • et al.
        Outcomes following oesophagectomy in patients with oesophageal cancer: a secondary analysis of the ICNARC case mix programme database.
        Crit Care. 2009; 13: S1
        • Dickstein D.R.
        • Egerman M.
        • Monrose E.
        • et al.
        Treatment tolerability and outcomes in elderly patients with head and neck cancer.
        Head Neck. 2021; 43: 858-873
        • Gordon S.A.
        • Reiterate E.R.
        Effectiveness of critical care pathways for head and neck cancer surgery: a systematic review.
        Head Neck. 2016; 38: 1421-1427
        • Dort J.C.
        • Farwell D.G.
        • Findlay M.
        • et al.
        Optional perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society.
        JAMA Otolaryngol Head Neck Surg. 2017; 143: 292-303
        • Waller J.
        • Schwaiger M.
        • Edmondson S.J.
        • et al.
        Effects of pre-operative risk factors on intensive care unit length of stay (ICU-LOS) in major oral and maxillofacial cancer surgery.
        Cancers (Basel). 2021; 13: 3937
        • Murray A.
        • Dempster J.
        BAHNO surgical specialties: same patients, different practices?.
        J Laryngol Otol. 2005; 119: 97-101
        • Panwar A.
        • Smith R.
        • Lydiatt D.
        • et al.
        Vascularised tissue transfer in head and neck surgery: is intensive care unit-based management necessary?.
        Laryngoscope. 2016; 126: 73-79
        • Yalamanchi P.
        • Thomas W.W.
        • Workman A.D.
        • et al.
        Value of intensive care unit-based postoperative management for microvascular free flap reconstruction in head and neck surgery.
        Facial Plast Surg Aesthet Med. 2021; 23: 49-53
        • Arshad A.
        • Gulcin Ozer H.
        • Thatcher A.
        • et al.
        Intensive care unit versus non-intensive care unit postoperative management of head and neck free flaps: comparative effectiveness and cost comparisons.
        Head Neck. 2014; 36: 536-539
        • Aponte-Ortiz J.A.
        • Greenberg-Worisek A.J.
        • Marinelli J.P.
        • et al.
        Cost and clinical outcomes of postoperative intensive care unit versus general floor management in head and neck free flap reconstructive surgery patients.
        Am J Otolaryngol. 2021; 42103029
        • Varadarajan V.V.
        • Arshad H.
        • Dziegielewski P.T.
        Head and neck free flap reconstruction: what is the appropriate post-operative level of care?.
        Oral Oncol. 2017; 75: 61-66
        • Coyle M.J.
        • Tyrell R.
        • Godden A.
        • et al.
        Replacing tracheostomy with overnight intubation to manage the airway in head and neck oncology patients: towards an improved recovery.
        Br J Oral Maxillofac Surg. 2013; 51: 491-496
        • Tamplen M.L.
        • Ricceri S.
        • Hemmat S.
        • et al.
        Benefits of immediate extubation following free tissue transfer for head and neck reconstruction.
        J Reconstr Microsurg. 2016; 32: 533-539
        • Ganly I.
        • Gross N.D.
        • Patel S.G.
        • et al.
        Outcome of craniofacial resection in patients 70 years of age and older.
        Head Neck. 2007; 29: 89-94