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Article

Effects of Pre-Operative Risk Factors on Intensive Care Unit Length of Stay (ICU-LOS) in Major Oral and Maxillofacial Cancer Surgery

1
Department of Oral & Maxillofacial Surgery, Medical University of Graz, 8036 Graz, Austria
2
Department of Cranio-Maxillofacial Surgery, AZ Monica and the University Hospital Antwerp, 2018 Antwerp, Belgium
3
Department of Plastic and Reconstructive Surgery, Guy’s and St. Thomas’ Hospital, London SE1 7EH, UK
4
University Clinic of Dental Medicine and Oral Health, Medical University of Graz, 8036 Graz, Austria
5
Institute for Computer Graphics and Vision, Graz University of Technology, 8036 Graz, Austria
*
Author to whom correspondence should be addressed.
Academic Editor: David Wong
Cancers 2021, 13(16), 3937; https://doi.org/10.3390/cancers13163937
Received: 2 July 2021 / Revised: 27 July 2021 / Accepted: 2 August 2021 / Published: 4 August 2021
(This article belongs to the Special Issue Head and Neck Cancer Imaging and Image Analysis)
This study aimed to investigate the effect of certain pre-operative parameters from the clinical routine directly on the post-operative intensive care unit (ICU)-length of stay (LOS) after major oral and maxillofacial cancer surgery. This study was performed to identify at-risk patients that are expected to need prolonged specialized care management post-operatively to these aforementioned operations. A homogenous cohort of 122 patients over a five year period was included in this study. At-risk patients are prone to need a significantly longer specialized care management than others. These patients are those with pre-operative severe renal dysfunction, peripheral vascular diseases and/or increasing heart failure stage categories. Confounding parameters that contribute to a prolonged specialized post-operative management in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.
Objective: This study aimed to investigate the effect of certain pre-operative parameters directly on the post-operative intensive care unit (ICU)-length of stay (LOS), in order to identify at-risk patients that are expected to need prolonged intensive care management post-operatively. Material and Methods: Retrospectively, patients managed in an ICU after undergoing major oral and maxillofacial surgery were analyzed. Inclusion criteria entailed: age 18–90 years, major primary oral cancer surgery including tumor resection, neck dissection and microvascular free flap reconstruction, minimum operation time of 8 h. Exclusion criteria were: benign/borderline tumors, primary radiation, other defect reconstruction than microvascular, treatment at other centers. Separate parameters used within the clinical routine were set in correlation with ICU-LOS, by applying single testing calculations (t-tests, variance analysis, correlation coefficients, effect sizes) and a valid univariate linear regression model. The primary outcome of interest was ICU-LOS. Results: This study included a homogenous cohort of 122 patients. Mean surgery time was 11.4 (±2.2) h, mean ICU-LOS was 3.6 (±2.6) days. Patients with pre-operative renal dysfunction (p < 0.001), peripheral vascular disease-PVD (p = 0.01), increasing heart failure-NYHA stage categories (p = 0.009) and higher-grade categories of post-operative complications (p = 0.023) were identified as at-risk patients for a significantly prolonged post-operative ICU-LOS. Conclusions: At-risk patients are prone to need a significantly longer ICU-LOS than others. These patients are those with pre-operative severe renal dysfunction, PVD and/or high NYHA stage categories. Confounding parameters that contribute to a prolonged ICU-LOS in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood. View Full-Text
Keywords: risk factors; length of stay; ICU-LOS; oral cancer; microvascular; free flap reconstruction risk factors; length of stay; ICU-LOS; oral cancer; microvascular; free flap reconstruction
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MDPI and ACS Style

Wallner, J.; Schwaiger, M.; Edmondson, S.-J.; Mischak, I.; Egger, J.; Feichtinger, M.; Zemann, W.; Pau, M. Effects of Pre-Operative Risk Factors on Intensive Care Unit Length of Stay (ICU-LOS) in Major Oral and Maxillofacial Cancer Surgery. Cancers 2021, 13, 3937. https://doi.org/10.3390/cancers13163937

AMA Style

Wallner J, Schwaiger M, Edmondson S-J, Mischak I, Egger J, Feichtinger M, Zemann W, Pau M. Effects of Pre-Operative Risk Factors on Intensive Care Unit Length of Stay (ICU-LOS) in Major Oral and Maxillofacial Cancer Surgery. Cancers. 2021; 13(16):3937. https://doi.org/10.3390/cancers13163937

Chicago/Turabian Style

Wallner, Juergen, Michael Schwaiger, Sarah-Jayne Edmondson, Irene Mischak, Jan Egger, Matthias Feichtinger, Wolfgang Zemann, and Mauro Pau. 2021. "Effects of Pre-Operative Risk Factors on Intensive Care Unit Length of Stay (ICU-LOS) in Major Oral and Maxillofacial Cancer Surgery" Cancers 13, no. 16: 3937. https://doi.org/10.3390/cancers13163937

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