Preoperative Care Clinic Improves Survival for Patients Undergoing Free-Flap Reconstruction.

Abstract

This study aims to evaluate whether perioperative care improves postoperative outcomes for head and neck reconstruction patients with preexisting health conditions. Retrospective cohort study. Single tertiary academic center between 2013 and 2021. This study included adult patients who underwent free-flap reconstruction for head and neck cancer. Patients who received perioperative care were compared with patients who received our institution's standard of care. Comorbid health conditions were measured using the Charlson comorbidity index (CCI) excluding solid tumors. Primary outcomes were major and minor complications, length of hospital stay (LOS), days in intensive care unit (ICU), discharge to acute/subacute facility, hospital-free days, and overall survival (OS). Interaction models were specified to evaluate the impact of preoperative care with respect to CCI. Of the 148 patients included, 83 received perioperative care and 65 received institutional standard of care (mean [SD]: age, 62.1 [10.8]; male, 100 [67.6%]; CCI  <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> </semantics> </math>  4, 43 [29.1%]). Patients with higher CCI who received perioperative care spent fewer days in the hospital (CCI 3: coefficient [ <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mi>β</mi> <mo>]</mo></mrow> </mrow> </semantics> </math> , -5.50; P = .012 and CCI  <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> </semantics> </math>  4: <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mi>β</mi></mrow> </mrow> </semantics> </math> , -6.41; P = .022) and ICU (CCI 3: <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mi>β</mi></mrow> </mrow> </semantics> </math> , -2.90; P = .002 and CCI  <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> </semantics> </math>  4: <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mi>β</mi></mrow> </mrow> </semantics> </math> , -6.54; P = .001), gained more hospital-free days (CCI  <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> </semantics> </math>  4: <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mi>β</mi></mrow> </mrow> </semantics> </math> , 17.00; P = .002), and had improved OS (CCI  <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> </semantics> </math>  4: adjusted hazard ratio [aHR], 0.14; P = .023). Perioperative care was not significantly associated with lower rates of major and minor complications or placement at a facility. Perioperative care provides a robust benefit for patients with medical comorbidities undergoing head and neck reconstruction, but this effect incrementally decreases for healthier patients.