Intensive care unit versus non-intensive care unit postoperative management of head and neck free flaps: comparative effectiveness and cost comparisons.

ABSTRACT

BACKGROUND: Despite its widespread use, there is no consensus on the postoperative management in patients undergoing free flap reconstructions. We report the largest study comparing flap outcomes, morbidity, and cost in patients with head and neck cancer free flaps who recovered in the intensive care unit (ICU) versus a "specialty floor" setting. METHODS: This was a retrospective review of patients undergoing free flap surgery for head and neck defects over a 4-year period. Patients before a certain date went to the ICU for immediate postoperative care and after to a non-ICU setting. Postoperative medical and surgical complications and hospital charges were analyzed. RESULTS: Patients in the ICU group had a longer length of stay (LOS) and incurred greater hospital costs than the patients in the non-ICU setting. There was no difference in the flap failure rate between the 2 groups. CONCLUSION: Consideration should be given to a floor-based postoperative management regimen for this patient population.