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J Reconstr Microsurg 2017; 33(04): 252-256
DOI: 10.1055/s-0036-1597757
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does a Standalone Cancer Center Improve Head and Neck Microsurgical Outcomes?

Matthew L. Tamplen
1   Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
,
Jesse Tamplen
2   Lean Transformation Office, University of California San Francisco, San Francisco, California
,
Vanessa Torrecillas
3   George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
,
Rahul Seth
1   Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
,
Santo Ricceri
1   Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
4   School of Medicine, University of California San Francisco, San Francisco, California
,
Shirin Hemmat
1   Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
4   School of Medicine, University of California San Francisco, San Francisco, California
,
Chase Heaton
1   Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
,
William R. Ryan
1   Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
,
P. Daniel Knott
1   Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
› Author Affiliations
Further Information

Publication History

09 September 2016

16 November 2016

Publication Date:
06 January 2017 (online)

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Abstract

Objectives To evaluate the role of hospital setting (standalone cancer center vs. large multidisciplinary hospital) on free tissue transfer (FTT) outcomes for head and neck reconstruction.

Methods Medical records were reviewed of 180 consecutive patients undergoing FTT for head and neck reconstruction. Operations occurred at either a standalone academic cancer center (n = 101) or a large multidisciplinary academic medical center (n = 79) by the same surgeons. Patient outcomes, operative comparisons, and hospital costs were compared between the hospital settings.

Results The cancer center group had higher mean age (65.2 vs. 60 years; p = 0.009) and a shorter mean operative time (12.3 vs. 13.2 hours; p = 0.034). Postoperatively, the cancer center group had a significantly shorter average ICU stay (3.45 vs. 4.41 days; p < 0.001). There were no significant differences in medical or surgical complications between the groups. Having surgery at the cancer center was the only significant independent predictor of a reduced ICU stay on multivariate analysis (Coef 0.73; p < 0.020). Subgroup analysis, including only patients with cancer of the aerodigestive tract, demonstrated further reduction in ICU stay for the cancer center group (3.85 vs. 5.1 days; p < 0.001). A cost analysis demonstrated that the reduction in ICU saved $223,816 for the cancer center group.

Conclusion Standalone subspecialty cancer centers are safe and appropriate settings for FTT. We found both reduced operative time and ICU length of stay, both of which contributed to lower overall costs. These findings challenge the concept that FTT requires a large multidisciplinary hospital.

Level of Evidence 4.

Keywords

head and neck reconstructive surgery - microvascular surgery - outcomes - cost-effectiveness

Note

The article was presented at the Triological Combined Sections Meeting, January 22–24, 2016, Miami Beach, Florida.