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Head and Neck Reconstruction Utilizing Free Tissue Transfer, Does Training in Otolaryngology or Plastic Surgery have an Effect on Outcomes?
Ian C. Hoppe, MD, Anthony M. Kordahi, BA, Edward S. Lee, MD.
Rutgers, The state university of New Jersey - New Jersey Medical School, Newark, NJ, USA.
PURPOSE: The reconstruction of defects resulting from the extirpation of head and neck neoplasms is performed by both otolaryngology and plastic surgery services, mostly dependent on the institution. Very little, if any, literature exists comparing differences between these two services and their reconstructions, specifically outcomes. The American College of Surgeons’ National Surgical Quality Improvement Project (NSQIP) provides a unique opportunity to examine a predefined set of variables with regards to free vascularized tissue transfers performed by each service.
METHODS: Following institutional review board approval the NSQIP Participant Use Files for 2005 - 2011 were examined for all Current Procedural Terminology codes regarding free tissue transfer. The results were further refined to include only primary ICD-9 codes involving a neoplasm of the head or neck. Each record was examined to determine which service performed the free tissue reconstruction. Outcome variables examined included total operative time, total hospital stay, wound complications, flap failures, and other selected outcomes.
RESULTS: During this time period a total of 534 flaps were performed, 213 by plastic surgery and 321 by otolaryngology. The average age was 61.8, with 367 males and 166 females (sex of 1 patient not provided). The average operative time was 578 and 567 minutes for plastic surgery and otolaryngology, respectively (p = 0.52). When further refining the analysis to resections performed by otolaryngology, there was no difference in operative time when the same surgical team performed the flap, or when another team performed the reconstruction. Total hospital length of stay was 12.9 and 11.2 days for plastic surgery and otolaryngology, respectively (p < 0.05). There were no significant differences noted between surgical site infections, wound dehiscence, and flap failure between flaps performed by plastic surgery and otolaryngology. In addition there were no significant differences noted between blood transfusion, return to operating room, postoperative pneumonia, and myocardial infarctions between the two services. Patients undergoing flaps performed by plastic surgery were significantly more likely to be on a ventilator 48 hours postoperatively (p < 0.005).
CONCLUSION: This study shows similar results with regards to free vascularized tissue transfers when performed by plastic surgery and otolaryngology. Plastic surgeons may be less familiar with airway management than otolaryngologists, possibly explaining the increased likelihood of the patient being ventilated for more than 48 hours postoperatively. The similar outcomes between the two services indicate that each specialty receives adequate training in microsurgery.
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