Perioperative factors limiting the discharge of patients treated with microvascular reconstruction after oral cancer resection.

BACKGROUND

Enhanced Recovery After Surgery (ERAS®) protocols reduce length of stay (LOS) in patients with head and neck cancer, but outcomes remain variable in heterogeneous study populations. This retrospective cohort study investigates factors responsible for prolonged hospitalization after oral cancer resection and microvascular reconstruction. To enable targeted patient care and reduce LOS, we propose functional discharge criteria to be fulfilled before discharge.

METHODS

Factors limiting the discharge of 95 patients were recorded on each postoperative day throughout hospitalization, to assess at what point a limiting factor remained unsolved. Spearman's rank correlation and linear regression were used to assess the association between demographic and surgical variables and LOS.

RESULTS

The mean LOS was 13.98 days, with common limiting factors for discharge being insufficient nutritional intake, tracheostomy, infection, immobilization, and ICU stay. Severity of complications and LOS was correlated (P < .001), but no correlation between comorbidities and LOS (P = .37) was found. The use of tracheostomy (P < .001) and ambulation after first postoperative day (P = .035) independently increased LOS.

CONCLUSIONS

The study recommends functional discharge criteria that include adequate nutrition, effective pain management, no suspected infections, tracheostomy closure, and normal bowel function. Early ambulation and a selective, individualized approach to tracheostomy are suggested to enhance outcomes.