Does Involvement of Medicine in Care of Head and Neck Free Tissue Transfer Patients Improve Outcomes?

To investigate whether routine involvement of the medical hospitalist service (MHS) in postoperative medical management of head and neck cancer (HNC) patients undergoing major ablative head and neck surgery with free tissue transfer (FTT) improves inpatient outcomes.

This is a retrospective cohort study. Patients undergoing FTT after head and neck oncologic surgery between 2014 and 2022 were identified. Starting September 2018, MHS were involved in the medical care of every FTT patient (post-intervention). Prior to that, MHS were consulted on an as-needed basis (pre-intervention). Outcomes studied included transfer to a higher level of care (LOC), length of hospital stay (LOHS), 30-day readmission, and 90-day mortality. Data were analyzed using linear regression and generalized linear models.

A total of 362 patients were included in this study (mean age 62.3 ± 10.5 and 30.1% females), 32.9% of the cohort being in the pre-intervention group. When comparing the post-intervention to pre-intervention groups, the risk difference (RD) for: (1) transfer to higher LOC was -7.4% (95% CI = -13.7 to -1.02, p = 0.02); (2) 30-day readmission was -4.4% (95% CI = -14.0 to 5.3%, p = 0.36); and (3) 90-day mortality was 2.4% (95% CI = -4.1 to 8.8, p = 0.49). Post-intervention, the LOHS decreased by 1.2 days compared to pre-intervention (95% CI = -3.9 to 1.5, p = 0.39).

Involvement of MHS in the care of patients undergoing FTT halved the relative risk of transfer to higher LOC. There was no significant effect on mortality, readmission, or hospital stay. Further studies are needed to confirm our findings.