Postoperative Medical Complications???-Not Microsurgical Complications???-Negatively Influence the Morbidity, Mortality, and True Costs after Microsurgical Reconstruction for Head and Neck Cancer
ABSTRACT Immediate reconstruction of composite head and neck defects using free tissue transfer is an accepted treatment standard. There remains, however, ongoing debate on whether the costs associated with this reconstructive approach merit its selection, especially considering poor patient prognoses and the high cost of care.
A retrospective review of the last 100 consecutive patients undergoing microsurgical reconstruction for head and neck cancer by the two senior surgeons was performed to determine whether microsurgical complications or postoperative medical complications had the more profound influence on morbidity and mortality outcomes and the true costs of these reconstructions.
Two patients required re-exploration of the microsurgical anastomoses, for a re-exploration rate of 2 percent, and one flap failed, for a flap success rate of 99 percent. The major surgical complication rate requiring a second operative procedure was 6 percent. Sixteen percent had minor surgical complications related to the donor site. Major medical complications, defined as a significant risk to the patient's life, occurred in 5 percent of the patients, but there was a 37 percent incidence of "minor" medical complications primarily caused by pulmonary problems and alcohol withdrawal. Postsurgical complications almost doubled the average hospital stay from 13.5 days for those patients without complications to 24 days for patients with complications. Thirty-six percent of the true cost of microsurgical reconstruction of head and neck cancer was due to the intensive care unit and hospital room costs, and 24 percent was due to operating room costs. Postsurgical complications resulted in a 70.7 percent increase in true costs, reflecting a prolonged stay in the intensive care unit and not an increase in operating room costs or regular hospital room costs.
Postoperative medical complications in these elderly, debilitated patients related to pulmonary problems and alcohol withdrawal were statistically far more important in negatively affecting the outcomes and true costs of microsurgical reconstruction.
- SourceAvailable from: Thomas G Poder
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- "The studies conducted by Schusterman et al. , Kroll et al. , Hidalgo et al. , Nakatsuka et al. , Jones et al. , Smit et al.  and Spiegel and Polat  indicate that the free flap technique for tissue reconstruction is very effective, with success rates of about 95% or higher (including salvage procedures). However, a major limitation to this success is the risk of compromised perfusion of the free flap. "
ABSTRACT: OBJECTIVE: The purpose of this paper is to evaluate the efficacy and cost-effectiveness of the implantable Doppler system based on the analysis of the available scientific literature and clinical and cost data available in our hospital. The results of this system are compared to those of conventional free flap monitoring methods. MATERIALS AND METHODS: The literature published between 1991 and 2011 was systematically reviewed. All available cost data were collected and several simulations were performed. A retrospective assessment of the efficacy of conventional methods in our hospital was also conducted. RESULTS AND CONCLUSION: The implantable Doppler system is more effective than the conventional methods used to monitor free flap perfusion. The mean flap salvage rate with the implantable Doppler was 21 percentage points higher (81.4 vs. 60.4). The excess cost compared to conventional methods was about CAD 120 per patient (about EUR 94). However, this excess cost can be compensated or even reversed, depending on the initial flap salvage rate in the health facility and the type of free flap (buried vs. non-buried).European Annals of Otorhinolaryngology, Head and Neck Diseases 04/2013; 130(2):79-85. DOI:10.1016/j.anorl.2012.07.003
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ABSTRACT: A thin layer of low temperature grown GaAs (LT-GaAs) incorporated in the intrinsic layer of a pin diode was used, to investigate the deep electronic defect centers in LT-GaAs, DC and AC n-channel conductance measurements and electro-absorption experiments as a function of reverse bias provide important information about the density, the energy distribution and the charging and discharging kinetics of the deep centers in the energy gapSemiconducting and Insulating Materials Conference, 2000. SIMC-XI. International; 02/2000
- Plastic and Reconstructive Surgery 03/2008; 121(2):675-6. DOI:10.1097/01.prs.0000298520.87892.74 · 3.33 Impact Factor