Effects of pre-operative risk factors on intensive care unit length of stay (ICU-LOS) in major oral and maxillofacial cancer surgery

Wallner, Juergen; Schwaiger, Michael; Edmondson, Sarah-Jayne; Mischak, Irene; Egger, Jan; Feichtinger, Matthias; Zemann, Wolfgang; Pau, Mauro

doi:10.3390/CANCERS13163937

Title

Effects of pre-operative risk factors on intensive care unit length of stay (ICU-LOS) in major oral and maxillofacial cancer surgery

Author

Wallner, Juergen

Schwaiger, Michael

Edmondson, Sarah-Jayne

Mischak, Irene

Egger, Jan

Feichtinger, Matthias

Zemann, Wolfgang

Pau, Mauro

Abstract

Simple Summary This study aimed to investigate the effect of certain pre-operative parameters from the clinical routine directly on the post-operative intensive care unit (ICU)-length of stay (LOS) after major oral and maxillofacial cancer surgery. This study was performed to identify at-risk patients that are expected to need prolonged specialized care management post-operatively to these aforementioned operations. A homogenous cohort of 122 patients over a five year period was included in this study. At-risk patients are prone to need a significantly longer specialized care management than others. These patients are those with pre-operative severe renal dysfunction, peripheral vascular diseases and/or increasing heart failure stage categories. Confounding parameters that contribute to a prolonged specialized post-operative management in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood. Objective: This study aimed to investigate the effect of certain pre-operative parameters directly on the post-operative intensive care unit (ICU)-length of stay (LOS), in order to identify at-risk patients that are expected to need prolonged intensive care management post-operatively. Material and Methods: Retrospectively, patients managed in an ICU after undergoing major oral and maxillofacial surgery were analyzed. Inclusion criteria entailed: age 18-90 years, major primary oral cancer surgery including tumor resection, neck dissection and microvascular free flap reconstruction, minimum operation time of 8 h. Exclusion criteria were: benign/borderline tumors, primary radiation, other defect reconstruction than microvascular, treatment at other centers. Separate parameters used within the clinical routine were set in correlation with ICU-LOS, by applying single testing calculations (t-tests, variance analysis, correlation coefficients, effect sizes) and a valid univariate linear regression model. The primary outcome of interest was ICU-LOS. Results: This study included a homogenous cohort of 122 patients. Mean surgery time was 11.4 (+/- 2.2) h, mean ICU-LOS was 3.6 (+/- 2.6) days. Patients with pre-operative renal dysfunction (p < 0.001), peripheral vascular disease-PVD (p = 0.01), increasing heart failure-NYHA stage categories (p = 0.009) and higher-grade categories of post-operative complications (p = 0.023) were identified as at-risk patients for a significantly prolonged post-operative ICU-LOS. Conclusions: At-risk patients are prone to need a significantly longer ICU-LOS than others. These patients are those with pre-operative severe renal dysfunction, PVD and/or high NYHA stage categories. Confounding parameters that contribute to a prolonged ICU-LOS in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.

Language

English

Source (journal)

Cancers

Publication

2021

ISSN

2072-6694

DOI

10.3390/CANCERS13163937

Volume/pages

13 :16 (2021) , 17 p.