The Effects of Intensive Care Unit Staffing on Patient Outcomes Following Microvascular Free Flap Reconstruction of the Head and Neck A Pilot Study

Objective: To determine if the implementation of the closed intensive care unit (ICU) at our institution altered clinical outcomes in patients who had undergone microvascular free flap reconstruction of the head and neck by the Otolaryngology-Head and Neck Surgery Service. Design: Retrospective medical chart review. Setting: A single tertiary medical center. Patients: The open ICU cohort had 52 flaps performed on 50 patients, and the closed ICU cohort had 52 flaps performed on 52 patients. Main Outcome Measures: Fifty-two free flap reconstructions of head and neck defects were performed on 50 patients who were admitted to an open ICU. The length of stay (LOS) in the ICU and hospital and incidence of complications were compared with those of 52 patients who underwent 52 free flap reconstructions and were admitted to a closed ICU over a separate period. Results: The mean length of stay in the ICU was 44 and 45 hours in the open and closed ICU cohorts, respectively (P=.90). The incidence of surgical and medical complications was similar in the open and closed ICU cohorts (P>.05). Conclusions: There does not appear to be a significant difference in patient outcome between open and closed ICU care in our study. JAMA Otolaryngol Head Neck Surg. 2013;139(1):37-42