Retrospective study on the need of intensive care unit admission after major head and neck surgery

The present article aims to study the pattern and need of Intensive Care Unit admission after major head and neck operations.

A retrospective study was undertaken of the hospital records of patients who underwent major head and neck operations during the period from February 1997 to February 2000 at the Division of Head and Neck Surgery, Department of Surgery, the Chinese University of Hong Kong.

A total of 268 consecutive elective major operations were carried out over the 3 year period. The patients' age ranged from 14 to 82 years with a mean of 55 years. The male to female ratio was 4:1. Forty-seven patients underwent an operation with a combination of major resection, neck dissection, flap reconstruction and tracheostomy ('flaps group'). Two hundred and twenty-one patients had major head and neck operations without the need of flap reconstruction ('non-flaps group'). Three (6.3%) out of 47 patients (flaps group) were admitted to intensive care unit (ICU) immediately after the operation. Only one patient (2.2%) out of the remaining 44 patients was admitted for emergency treatment 3 weeks post operation. All four patients recovered uneventfully. In the non-flaps group of 221 patients, there were 12 (5.4%) planned admissions and 2 (0.96%) unplanned admissions to ICU. In the group of planned admissions, one out of the 12 patients died. The other two patients who were not planned for ICU admission died of basal meningitis that was disease-related rather than related to the intensity of postoperative care. The overall admission rate to ICU was 18 (6.7%) out of 268 patients. The overall mortality was 1.1% (one planned, two unplanned).

The present study showed that it is safe and cost-effective to discharge the majority of patients after major head and neck operations back to a specialist ward for nursing care.