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Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Session: Scientific Oral Presentation 1 - Facial Plastics and Reconstructive Surgery

Hospitalization Ratio after Major Oncologic Head and Neck surgery with Microvascular Free Flap

Sunday, October 12, 2025

1:30 PM - 1:36 PM EDT

Location: 137

Disclosure(s):

Nana-Hawwa Abdul-Rahman, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Alexandria L. Harris, MS, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Matthew E. Spector, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Carl H. Snyderman, MD, MBA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Unplanned 60-day ED visits and readmission after hospital discharge following head and neck surgery with microvascular free flap reconstruction (MVFF) significantly increase healthcare costs. The primary length of stay (PLOS) metric alone fails to capture the added time, costs, and reduced patient quality of life. To address these limitations, we propose a novel metric, the hospitalization ratio (HR), which integrates PLOS and readmission LOS (RLOS). We hypothesize that patients with shorter PLOS are more likely to represent and that HR is non-inferior to PLOS as an outcome metric.

Methods: This retrospective chart review included 626 patients who underwent MVFF at our institution from August 2019 to May 2024. Our main outcome measure was HR calculated as total length of stay (TLOS = [PLOS+RLOS]) / 60 days.

Results: The average age was 62.7 years (SD: 11.9), with a male predominance (68.2%). The mean PLOS was 12.4 (SD: 9.1) days, RLOS was 4.37 (7.17), and HR was 0.22 (0.15). Patients with shorter PLOS were more likely to represent [mean PLOS: 11.2 (10.2) vs. 13.0 (6.5), p= 0.02]. Longer surgeries (R=0.11, p=0.004), advanced tumors [stage 3/4 mean HR: 0.25 (0.17) vs. 0.21 (0.19), p=0.02], public insurance [mean HR: 0.25 (0.18) vs. 0.21 (0.14), p=0.003], ICU admission [mean HR: 0.33 (0.25) vs. 0.22 (0.17), p=0.01], postoperative complications [mean HR: 0.30 (0.23) vs. 0.19 (0.11), p< 0.001], tracheostomy at discharge [mean HR: 0.26 (0.21) vs. 0.22 (0.16), p=0.04], and treatment cost (R =0.63, p< 0.001) were associated with a higher HR. Similar factors were associated with PLOS. Multivariable linear regression identified private insurance (Beta= -0.04, p=0.02), postoperative complications (Beta = 0.05, p=0.004), and treatment cost (Beta= 0.05, p< 0.001) as independent predictors of HR. Similar factors were associated with PLOS.

Conclusions: Representation after primary discharge significantly impacts patient quality of life and healthcare costs, particularly in patients with shorter PLOS. HR provides a more comprehensive assessment of healthcare utilization compared to PLOS.

Presenting Author(s)

Nana-Hawwa Abdul-Rahman, MS

Medical Student
University of Pittsburgh
Pittsbrugh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Anthony J. Tang, BS

Medical Student
University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
ZB

Zainab A. Balogun, MS

Medical Student
Univeristy of Pittsburgh
PITTSBURGH, Pennsylvania, United States

Disclosure information not submitted.
AH

Alexandria L. Harris, MS, MD

Resident Physician
University of Pittsburgh Medical Center - Medical Education Program
Pittsburgh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
SS

Shaum S. Sridharan, MD

Associate Professor
Department of Otolaryngology, University of Pittsburgh Medical Center
Pittsburgh, PA, United States

Disclosure information not submitted.
Matthew E. Spector, MD

Professor
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh
Pittsburgh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Carl H. Snyderman, MD, MBA

Professor of Otolaryngology and Neurological Surgery
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.