Intensive Care Unit Versus Ward Management After Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Whether postoperative care in the intensive care unit (ICU) is a necessity for patients undergoing head and neck free flap reconstruction remains debatable. In August 2012, our institute initiated a policy to care for these patients in the ICU, opposed to the previous policy of care in the ward. Thus, we used this opportunity to compare outcomes between these 2 care approaches. PATIENTS AND METHODS: Patients with oral cancer who underwent cancer ablation and immediate anterolateral thigh flap reconstruction from August 2010 to July 2014 were included in this retrospective study. Patients who simultaneously received an additional flap reconstruction were excluded. Before August 2012, these patients were routinely transferred to the ward for postoperative care (ward group, n = 179). Since August 2012, these patients have routinely been transferred to the ICU for postoperative care (ICU group, n = 138). RESULTS: Both groups had comparable flap outcomes in terms of the rates of take-back, successful salvage, flap survival, and flap complication. Compared with the ward group, the ICU group showed an increased use of postoperative sedation (26.7% vs 6.8%, P = 0.000), a correspondingly longer use of mechanical ventilation (3.0 ± 2.7 days vs 0.4 ± 1.4 days, P = 0.000), and a higher incidence of sepsis (3.6% vs 0%, P = 0.015). CONCLUSIONS: Postoperative care of patients who have undergone anterolateral thigh flap reconstruction after oral cancer ablation in the ward or ICU resulted in comparable flap outcomes. Risks and benefits between ward and ICU postoperative management in terms of nursing workloads, monitoring facilities, use of sedation and mechanical ventilation, and potential for sepsis should be taken into consideration when defining postoperative care settings in these patients.

Original languageEnglish
Pages (from-to)S11-S14
JournalAnnals of plastic surgery
Volume80
Issue number2S Suppl 1
DOIs
Publication statusPublished - 2018 Feb 1

Fingerprint

Mouth Neoplasms
Thigh
Intensive Care Units
Postoperative Care
Artificial Respiration
Sepsis
Free Tissue Flaps
Workload
Patient Care
Nursing
Neck
Retrospective Studies
Head
Survival
Incidence
Neoplasms

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{b0e4dace83114ca3a02cf25e2518e092,
title = "Intensive Care Unit Versus Ward Management After Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation",
abstract = "BACKGROUND: Whether postoperative care in the intensive care unit (ICU) is a necessity for patients undergoing head and neck free flap reconstruction remains debatable. In August 2012, our institute initiated a policy to care for these patients in the ICU, opposed to the previous policy of care in the ward. Thus, we used this opportunity to compare outcomes between these 2 care approaches. PATIENTS AND METHODS: Patients with oral cancer who underwent cancer ablation and immediate anterolateral thigh flap reconstruction from August 2010 to July 2014 were included in this retrospective study. Patients who simultaneously received an additional flap reconstruction were excluded. Before August 2012, these patients were routinely transferred to the ward for postoperative care (ward group, n = 179). Since August 2012, these patients have routinely been transferred to the ICU for postoperative care (ICU group, n = 138). RESULTS: Both groups had comparable flap outcomes in terms of the rates of take-back, successful salvage, flap survival, and flap complication. Compared with the ward group, the ICU group showed an increased use of postoperative sedation (26.7{\%} vs 6.8{\%}, P = 0.000), a correspondingly longer use of mechanical ventilation (3.0 ± 2.7 days vs 0.4 ± 1.4 days, P = 0.000), and a higher incidence of sepsis (3.6{\%} vs 0{\%}, P = 0.015). CONCLUSIONS: Postoperative care of patients who have undergone anterolateral thigh flap reconstruction after oral cancer ablation in the ward or ICU resulted in comparable flap outcomes. Risks and benefits between ward and ICU postoperative management in terms of nursing workloads, monitoring facilities, use of sedation and mechanical ventilation, and potential for sepsis should be taken into consideration when defining postoperative care settings in these patients.",
author = "Chen, {Wei Chen} and Kuo-Shu Hong and Szu-Han Chen and Shyh-Jou Shieh and Jing-Wei Lee and Jenn-Ren Hsiao and Yao-Chou Lee",
year = "2018",
month = "2",
day = "1",
doi = "10.1097/SAP.0000000000001301",
language = "English",
volume = "80",
pages = "S11--S14",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "2S Suppl 1",

}

TY - JOUR

T1 - Intensive Care Unit Versus Ward Management After Anterolateral Thigh Flap Reconstruction After Oral Cancer Ablation

AU - Chen, Wei Chen

AU - Hong, Kuo-Shu

AU - Chen, Szu-Han

AU - Shieh, Shyh-Jou

AU - Lee, Jing-Wei

AU - Hsiao, Jenn-Ren

AU - Lee, Yao-Chou

PY - 2018/2/1

Y1 - 2018/2/1

N2 - BACKGROUND: Whether postoperative care in the intensive care unit (ICU) is a necessity for patients undergoing head and neck free flap reconstruction remains debatable. In August 2012, our institute initiated a policy to care for these patients in the ICU, opposed to the previous policy of care in the ward. Thus, we used this opportunity to compare outcomes between these 2 care approaches. PATIENTS AND METHODS: Patients with oral cancer who underwent cancer ablation and immediate anterolateral thigh flap reconstruction from August 2010 to July 2014 were included in this retrospective study. Patients who simultaneously received an additional flap reconstruction were excluded. Before August 2012, these patients were routinely transferred to the ward for postoperative care (ward group, n = 179). Since August 2012, these patients have routinely been transferred to the ICU for postoperative care (ICU group, n = 138). RESULTS: Both groups had comparable flap outcomes in terms of the rates of take-back, successful salvage, flap survival, and flap complication. Compared with the ward group, the ICU group showed an increased use of postoperative sedation (26.7% vs 6.8%, P = 0.000), a correspondingly longer use of mechanical ventilation (3.0 ± 2.7 days vs 0.4 ± 1.4 days, P = 0.000), and a higher incidence of sepsis (3.6% vs 0%, P = 0.015). CONCLUSIONS: Postoperative care of patients who have undergone anterolateral thigh flap reconstruction after oral cancer ablation in the ward or ICU resulted in comparable flap outcomes. Risks and benefits between ward and ICU postoperative management in terms of nursing workloads, monitoring facilities, use of sedation and mechanical ventilation, and potential for sepsis should be taken into consideration when defining postoperative care settings in these patients.

AB - BACKGROUND: Whether postoperative care in the intensive care unit (ICU) is a necessity for patients undergoing head and neck free flap reconstruction remains debatable. In August 2012, our institute initiated a policy to care for these patients in the ICU, opposed to the previous policy of care in the ward. Thus, we used this opportunity to compare outcomes between these 2 care approaches. PATIENTS AND METHODS: Patients with oral cancer who underwent cancer ablation and immediate anterolateral thigh flap reconstruction from August 2010 to July 2014 were included in this retrospective study. Patients who simultaneously received an additional flap reconstruction were excluded. Before August 2012, these patients were routinely transferred to the ward for postoperative care (ward group, n = 179). Since August 2012, these patients have routinely been transferred to the ICU for postoperative care (ICU group, n = 138). RESULTS: Both groups had comparable flap outcomes in terms of the rates of take-back, successful salvage, flap survival, and flap complication. Compared with the ward group, the ICU group showed an increased use of postoperative sedation (26.7% vs 6.8%, P = 0.000), a correspondingly longer use of mechanical ventilation (3.0 ± 2.7 days vs 0.4 ± 1.4 days, P = 0.000), and a higher incidence of sepsis (3.6% vs 0%, P = 0.015). CONCLUSIONS: Postoperative care of patients who have undergone anterolateral thigh flap reconstruction after oral cancer ablation in the ward or ICU resulted in comparable flap outcomes. Risks and benefits between ward and ICU postoperative management in terms of nursing workloads, monitoring facilities, use of sedation and mechanical ventilation, and potential for sepsis should be taken into consideration when defining postoperative care settings in these patients.

UR - http://www.scopus.com/inward/record.url?scp=85055241676&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055241676&partnerID=8YFLogxK

U2 - 10.1097/SAP.0000000000001301

DO - 10.1097/SAP.0000000000001301

M3 - Article

C2 - 29369910

AN - SCOPUS:85055241676

VL - 80

SP - S11-S14

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 2S Suppl 1

ER -