Postoperative monitoring in free tissue transfer patients: effective use of nursing and resident staff.

Abstract

To compare the outcomes of two different free flap monitoring protocols and determine whether nursing staff can safely and effectively monitor free flaps. Historical cohort study on all head and neck free tissue transfer patients from August 2003 to August 2007. Tertiary care teaching institution. The patients were divided into two groups according to monitoring protocol. Group A (n = 49) had free flaps monitored primarily by resident physicians, while Group B patients (n = 45) were evaluated primarily by nursing staff. Demographic and outcomes data, including complications, reoperations, length of hospital stay, and flap viability, were then compared. Overall, 28 (57%) patients in Group A and 16 (37%) in Group B had at least one complication (P = 0.05). Only eight patients in each group had major complications. There were 25 (27%) patients who required further intervention in the operating room: 18 (37%) in Group A and seven (16%) in Group B (P = 0.03). Only 12 (13%) patients returned to the operating room for concerns of flap viability: seven from Group A and five from Group B. The median length of hospital stay was 11 days for both groups (P = 0.76). The flap success rate was 95 percent, with three failures in Group A and two in Group B (P = 0.72). A monitoring protocol utilizing trained nursing staff has no detrimental effect on free tissue transfer outcomes. This may be used to optimize resident time within the current duty-hour restrictions.