Hospitalization Utilization Metric After Major Oncologic Head and Neck Surgery With Microvascular Free Flap

The primary length of stay (PLOS) metric fails to capture added time, costs, and reduced patient quality of life (QOL) associated with readmissions. To address these limitations, we propose a novel metric, the hospitalization utilization metric (HUM), which integrates PLOS and readmission LOS (RLOS).

Retrospective review of 626 head and neck microvascular free flap (MVFF) cases from August 2019 to May 2024.

University of Pittsburgh Medical Center.

Main outcome measure was HUM, calculated as total length of stay (TLOS) (TLOS = [PLOS + RLOS]/60 days). High HUM, determined by median split, was >0.18.

Our 626-patient cohort averaged 62.7 ± 11.9 years old. The majority of patients were male (68.2%), white (92.0%), with advanced tumors (III/IV: 74.1%), and public insurance (63.1%). The median (interquartile range [IQR]) PLOS was 9 (7-14), median (IQR) HUM was 0.18 (0.13-0.28), and the rate of 60-day re-presentation/readmission was 34.3%. Multivariable logistic regression identified postoperative complications (β: .08, P < .001; β: 4.44, P < .001, respectively) and private insurance (β: -.04, P < .02; -2.71, P < .01) as predictive factors associated with both higher HUM and PLOS (>9 days), respectively. Return to intensive care unit (ICU) (β: .08, P < .003) and duration of surgery (β: .005, P < .048) were independently associated with higher HUM, although both effect sizes are relatively small. Kaplan-Meier survival curves revealed that higher HUM (P = .030) but not PLOS (P = .098) was associated with worse survival 1 year postoperatively.

HUM provides a comprehensive assessment of healthcare utilization compared to PLOS and re-presentation alone and may be a practical surrogate for patient QOL and healthcare costs.