Early discharge after free-tissue transfer does not increase adverse events.

Abstract

INTRODUCTION\nDemonstrate that carefully selected free flap patients may be discharged early after surgery without increasing the rates of postoperative complications or readmissions.\n\n\nMETHODS\nBased on a published article in Laryngoscope 2016 of 51 free-tissue transfers, a retrospective chart review was performed on an expanded cohort who underwent free-tissue transfer for head and neck reconstruction between February 2010 and May 2018 and discharged by postoperative day 3.\n\n\nRESULTS\n101 patients who underwent 104 free flaps with average age of 56 (3-84) years old were reviewed. Free flap indications included orbital and maxillary defects (n\xa0=\xa022), palatal defects (n\xa0=\xa016), nasal and septal defects (n\xa0=\xa016), cranioplasty and scalp defects (n\xa0=\xa016), mandibular defects due to osteoradionecrosis (n\xa0=\xa014), facial contouring and parotid defects (n\xa0=\xa012), and complex postsurgical and radiotherapy wounds or fistula closure (n\xa0=\xa08). Free flaps performed were anterolateral thigh (n\xa0=\xa097), radial forearm (n\xa0=\xa02), serratus (n\xa0=\xa02), latissimus (n\xa0=\xa01), fibula (n\xa0=\xa01) and supraclavicular (n\xa0=\xa01). The recipient vessels used via minimal access approaches were facial (n\xa0=\xa043), superficial temporal (n\xa0=\xa029), angular (n\xa0=\xa020) and others. There were 3 flap failures (2.9%) recognized in follow-up. No flap failures or perioperative complications were associated with early discharge. There were only 2 patients readmitted and 1 watched in observation within 30\xa0days postoperatively.\n\n\nCONCLUSION\nAn updated review of our institutional experience with more than double the cohort size substantiates previous conclusions that early discharge after free-tissue transfer is a safe option in select patients. Moreover, earlier discharge is a critical management choice that reduces cost and decreases hospital-related adverse events.