Advertisement

Factors determining postoperative length of stay and time to resumption of feeding following free flap reconstruction for oral cancer

      Abstract

      Microvascular free tissue transfer reconstruction following resection of oral cancer is commonly chosen as the first line of treatment due to its superior functional outcomes. Multiple patient and surgical factors impact the length of postoperative stay, and the time taken for patients to recommence oral feeding. This study aimed to identify factors that increase the length of stay and time to resumption of feeding. We retrospectively evaluated 100 cases from March 2015 to October 2020, and identified variables associated with increased length of stay (LOS) and time to resumption of feeding in univariate and multivariate analyses. Factors found to be associated with increased LOS in multivariate analysis were increasing age, elective tracheostomy, tumours originating from the floor of the mouth and mandible, a longer operating time, and use of fibular free flaps (p<0.05). Tracheostomy, increasing age, and female gender were strongly associated with delays in resumption of some types of oral feeding, and an integrated critical care unit (ICCU) stay of two or more days was associated with a longer time to resumption of free fluids. This information can be used to anticipate extensions to typical LOS, to produce cost analyses, develop individual patient risk stratification, manage patient expectations, and target the use of enhanced recovery programmes.

      Keywords

      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:

      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

      References

        • Ho M.
        • Schache A.
        • Nugent M.
        • et al.
        Lessons learned from the multidisciplinary UK National Flap Registry initiative and plans for the future.
        Front Oral Maxillof Med. 2021; https://doi.org/10.21037/fomm-21-2
        • Schache A.
        • Kerawala C.
        • Ahmed O.
        • et al.
        British Association of Head and Neck Oncologists (BAHNO) standards 2020.
        J Oral Pathol Med. 2021; 50: 262-273https://doi.org/10.1111/jop.13161
        • Steele P.
        • McMahon J.
        • Dickson K.
        • et al.
        Applying the British Association of Oral and Maxillofacial Surgeons quality outcomes metrics to a UK oncology and reconstructive surgery service–benchmarking the data.
        Br J Oral Maxillofac Surg. 2021; 59: 1079-1084https://doi.org/10.1016/j.bjoms.2021.03.018
        • Girod A.
        • Brancati A.
        • Mosseri V.
        • et al.
        Study of the length of hospital stay for free flap reconstruction of oral and pharyngeal cancer in the context of the new French casemix-based funding.
        Oral Oncol. 2010; 46: 190-194https://doi.org/10.1016/j.oraloncology.2009.12.002
        • Jain P.V.
        • Bang B.
        • Manikantan K.
        • et al.
        Factors affecting postoperative complications after reconstructive surgery in oral carcinoma patients: a prospective study of 100 patients.
        Indian J Otolaryngol Head Neck Surg. 2019; 71: 341-347https://doi.org/10.1007/s12070-018-1304-9
        • Patel R.S.
        • McCluskey S.A.
        • Goldstein D.P.
        • et al.
        Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck.
        Head Neck. 2010; 32: 1345-1353https://doi.org/10.1002/hed.21331
        • Yang Y.
        • Li P.J.
        • Shuai T.
        • et al.
        Cost analysis of oral and maxillofacial free flap reconstruction for patients at an institution in China.
        Int J Oral Maxillofac Surg. 2019; 48: 590-596https://doi.org/10.1016/j.ijom.2018.10.020
        • Zubair F.
        • McMahon J.
        • Carson E.
        • et al.
        Unscheduled return to the operating theatre after head and neck surgery with free flap repair.
        Br J Oral Maxillofac Surg. 2022; 60: 554-557https://doi.org/10.1016/j.bjoms.2020.08.119
        • Tighe D.
        • Sassoon I.
        • Hills A.
        • et al.
        Case-mix adjustment in audit of length of hospital stay in patients operated on for cancer of the head and neck.
        Br J Oral Maxillofac Surg. 2019; 57: 866-872https://doi.org/10.1016/j.bjoms.2019.07.007
        • BuSaba N.Y.
        • Schaumberg D.A.
        Predictors of prolonged length of stay after major elective head and neck surgery.
        Laryngoscope. 2007; 117: 1756-1763https://doi.org/10.1097/MLG.0b013e3180de4d85
        • Ryan M.W.
        • Hochman M.
        Length of stay after free flap reconstruction of the head and neck.
        Laryngoscope. 2000; 110: 210-226https://doi.org/10.1097/00005537-200002010-00005
        • Liu Z.Q.
        • Wu H.X.
        • Cheng S.
        • et al.
        Unnecessary blood transfusion prolongs length of hospital stay of patients who undergo free fibular flap reconstruction of mandibulofacial defects: a propensity score–matched study.
        J Oral Maxillofac Surg. 2020; 78: 2316-2327https://doi.org/10.1016/j.joms.2020.07.213
        • Penel N.
        • Mallet Y.
        • Roussel-Delvallez M.
        • et al.
        Factors determining length of the postoperative hospital stay after major head and neck cancer surgery.
        Oral Oncol. 2008; 44: 555-562https://doi.org/10.1016/j.oraloncology.2007.07.003
        • Lindeborg M.M.
        • Sethi R.K.
        • Puram S.V.
        • et al.
        Predicting length of stay in head and neck patients who undergo free flap reconstruction.
        Laryngoscope Investig Otolaryngol. 2020; 5: 461-467https://doi.org/10.1002/lio2.410
        • Siddiqui A.S.
        • Dogar S.A.
        • Lal S.
        • et al.
        Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery.
        J Anaesthesiol Clin Pharmacol. 2016; 32: 49-53https://doi.org/10.4103/0970-9185.173341
        • Choi J.E.
        • Kim H.
        • Choi S.Y.
        • et al.
        Clinical outcomes of a 14-day in-hospital stay program in patients undergoing head and neck cancer surgery with free flap reconstruction under the National Health Insurance System.
        Clin Exp Otorhinolaryngol. 2019; 12: 308-316https://doi.org/10.21053/ceo.2018.01235
        • Kerawala C.J.
        • Riva F.
        • Paleri V.
        The impact of early oral feeding following head and neck free flap reconstruction on complications and length of stay.
        Oral Oncol. 2021; 113: 105094https://doi.org/10.1016/j.oraloncology.2020.105094
        • Guidera A.K.
        • Kelly B.N.
        • Rigby P.
        • et al.
        Early oral intake after reconstruction with a free flap for cancer of the oral cavity.
        Br J Oral Maxillofac Surg. 2013; 51: 224-227https://doi.org/10.1016/j.bjoms.2012.06.005