Characteristics of patients requiring prolonged mechanical ventilation following head and neck microvascular reconstructive procedures.

PURPOSE: Postoperative failure to wean from ventilator support is associated with poor outcomes. This study characterizes patients requiring prolonged ventilation after head-and-neck reconstructive surgery and their outcomes. METHODS: Patients who underwent head-and-neck reconstructive surgery were identified in the National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology (CPT) codes, ICD-10 codes, and free-text search. Hypothesis testing and regression analysis was utilized to compare patient characteristics and peri/postoperative complication rates between those with and without extended ventilation. Extended ventilation was defined as ventilation for ≥ 48 hours after operative start time. RESULTS: NSQIP contained 4661 patients who underwent free flap surgery; 180 experienced prolonged ventilation. Patients with primary oral cavity/sinonasal malignancy, preoperative ventilator dependence, and preoperative open wound/wound infection were more likely to experience prolonged ventilation. Prolonged ventilation patients experienced double the overall hospital stay, and increased rates of wound disruption, reoperation, and mortality. (p<0.05). CONCLUSION: Prolonged mechanical ventilation may significantly affect outcomes of free flap patients, including longer hospital stays, and higher 30-day mortality.