Head and Neck Reconstruction: Does Surgical Specialty Affect Complication Rates?

Area of Science:

• Surgical Outcomes
• Microsurgery
• Head and Neck Reconstruction

Background:

• Head and neck defect reconstruction is performed by both plastic surgeons and otolaryngologists.
• The American College of Surgeons National Surgical Quality Improvement (NSQIP) database enables specialty outcome comparisons.
• This study compares outcomes and resource utilization for microvascular head and neck reconstruction between specialties.

Purpose of the Study:

• To compare outcomes of microvascular head and neck reconstruction performed by plastic surgery versus otolaryngology.
• To evaluate resource utilization in head and neck free flap reconstructions based on surgical specialty.
• To identify differences in complication rates and length of stay between the two specialties.

Main Methods:

• Utilized the NSQIP database from 2005 to 2015.
• Included Current Procedural Terminology codes for free tissue transfer in head and neck reconstruction.
• Compared outcomes between plastic surgery and otolaryngology for free flap procedures.

Main Results:

• A total of 2,322 free flaps were performed; 893 by plastic surgery and 1,429 by otolaryngology.
• Plastic surgery had a longer average length of stay (13.7 days) compared to otolaryngology (11.4 days).
• Otolaryngology patients experienced significantly higher rates of complications, including surgical site infections, bleeding, sepsis, and readmissions (p < 0.05).

Conclusions:

• Plastic surgery patients exhibit superior outcomes in head and neck free tissue transfers compared to otolaryngology patients.
• Despite a longer length of stay, plastic surgery's lower complication rates suggest more optimal resource utilization.
• Further research may reveal cost savings associated with plastic surgery for these procedures.