(A606) Preoperative Predictors of Length of Hospitalization Following Head and Neck Free Flap Reconstruction

Introduction: Microvascular free tissue transfer is a primary method for reconstruction in patients with large or complex defects of the head and neck, with success rates of 95-99%. Average length of hospitalization following these procedures has been reported between 8-26 days. Many free flap patients have significant medical comorbidities, socioeconomic factors, or postoperative complications leading to increased length of hospitalization. The present study aims to determine preoperative factors predictive of increased length of hospitalization for patients undergoing free flap reconstruction for head and neck defects.

Methods: A retrospective chart review was performed of patients undergoing free flap reconstruction for head and neck defects at a single institution from 2022-2024. A multivariate analysis was conducted to determine preoperative factors predictive of length of hospitalization, including age, gender, race, ethnicity, BMI, primary insurance type, distance from patient’s primary residence to the hospital, preoperative laboratory values, history of surgery or radiation therapy, and smoking or alcohol use history.

Results: 99 patients were included in analysis. Average length of hospitalization was 11.5 days. On multivariate analysis, distance from patient’s primary residence to the hospital (p=0.0391), Charleston Comorbidity Index (p=0.0036), preoperative albumin (p=0.0013), preoperative hemoglobin (p=0.0006), and smoking history (p=0.0366) had a statistically significant impact on length of hospitalization. Primary insurance had marginally significant impact on the length of hospitalization (p = 0.0740 < 0.1).

Conclusions: Several preoperative factors are associated with increased length of hospitalization for patients undergoing microvascular reconstruction of head and neck defects, including distance from the hospital, preoperative albumin, preoperative hemoglobin, and history of smoking. Primary insurance had marginally significant impact on length of hospitalization. Notably, history of prior radiation or surgery did not have an impact.