Hospital Stay for Head, Neck Surgery Can Safely Shrink to Less Than One Week

Website: http://www.sic2004.org/

Newswise — Hospital stays for head and neck cancer patients following uncomplicated major head and neck tumor removal can be safely reduced from two to three weeks to less than one week, saving thousands of dollars. This conclusion can be found in the study, "Hospitalization after Major Oncologic Head and Neck Resections " How Low Can We Go?" The findings will be presented by author Edgar A. Lueg, MD, of the Microvascular Reconstructive Head & Neck Surgery Service, Regional Head, Neck, and Skullbase Surgical Oncology Center, Southern California Permanente Medical Group, Los Angeles, at the 6th International Conference on Head and Neck Cancer (http://www.sic2004.org) being held August 7-11, 2004, at the Wardman Park Marriott in Washington, DC.

Microvascular transplantation of tissue from the arms or legs to the mouth or throat to repair defects resulting from removal of an unusually large cancer is one of the most complex reconstructive head and neck cancer surgeries. Typically this surgery is among the most extensive head and neck surgeries performed, requiring 12 hours to complete. Uncomplicated recovery includes three to four days in intensive care with a total hospital stay of two to three weeks, at a cost of thousands of dollars per day.

Although previous studies have questioned whether or not hospital stays can be safely lowered. This study is the first of its kind to ask the question, "How low can we go?" by looking at the group of head and neck cancer patients who require the most post-operative in-patient recovery time.

Methodology: Two groups of 50 patients requiring removal of a malignant head and neck tumor resulting in a "major" anatomical defect large enough to require microvascular reconstruction were included in the study. The Pre-Pathway group and Post-Pathway groups were similar with respect to age, health, cancer site, cancer stage, and the type of reconstruction. The Post-Pathway group underwent a revised surgical plan ("Microvascular Pathway" or MP) that ended in discharge on the sixth post-operative day (without complications). The following outcomes were measured for both groups: length of hospital stay (LOS), major morbidity, mortality rate (any cause within 30 days), re-admission rate (any cause within 30 days of discharge), and time to adjuvant radiation.

Results: Results for the uncomplicated Pre-Pathway group included: LOS, mean 8.7 days (major complications were seen in ten cases and increased LOS up to three weeks); major morbidity: 26 percent; mortality rate: six percent; re-admission rate: 12 percent; time to radiation: 8.4 weeks.

Results for the uncomplicated Post-Pathway group included: LOS, mean 6.0 days (eight major complications increased LOS to more than two weeks); major morbidity: 18 percent; mortality rate: two percent; re-admission rate: ten percent; time to radiation: eight weeks.

Conclusion: Using the Microvascular Pathway can safely reduce uncomplicated hospitalizations for advanced head and neck resections to less than one week. Further reductions in LOS for uncomplicated head and neck resections may result in missing early lung complications. The results of this study suggest that future standards of care for head and neck cancer resection patients may include reduced hospital stays. However, the author suggests research at other centers is needed to verify the study's findings.