Should all head and neck cancer patients be nursed in intensive therapy units following major surgery?

Surgery remains a mainstay of treatment for head and neck cancer. Patients have significant comorbidities, and protracted surgery is associated with complications and may require a high-dependency nursing environment such as an intensive care or high-dependency unit postoperatively. The literature is reviewed to document the current evidence for early postoperative nursing care.

The mortality associated with major head and neck oncologic surgery is low, less than 3%, most frequently being myocardial infarction and pneumonia. The majority of patients can be nursed in a step-down (high-dependency unit) environment, which has one-to-one nursing, with experience and expertise, supported by medical staff. The decision where care is provided needs to be made locally, however, depending on staffing skill and levels, resources, and volume of workload.

The majority do not require the routine use of the intensive therapy unit in the immediate postoperative period. The use of a 'specialist care', high-dependency unit or ward is cost effective, without reducing quality of care. Appropriate and adequate nursing staff with experience and expertise, and sustained resourcing, is paramount to the implementation of such a care facility.