Free Tissue Transfer during the COVID-19 Pandemic: A Proposed Evidence-Based Protocol for Early Discharge

IF 0.9 Q3 SURGERY
M. Pontell, Alexandra L. Alving-Trinh, Sara Chaker, J. Winocour, Wesley P. Thayer
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引用次数: 2

Abstract

BACKGROUND As free tissue transfer outcomes improve, institutions are examining early discharge protocols. “Early” is generally defined as between one and five days postoperatively, which correlates with the timing of most major complications and most opportunities for flap salvage. Given the trend towards early discharge, the need for healthcare cost reductions and shortage of ICU beds during a viral pandemic, we aimed to propose an evidence-based protocol to select patients for discharge within 72 h of free tissue transfer. METHODS A retrospective review of all patients who underwent free tissue transfer at Vanderbilt University Medical Center, Tennessee, USA since the onset of the COVID-19 (2020-2021) pandemic was performed. Patients were included for review if they were discharged within 72 h of surgery. Literature relating to expedited discharge after free tissue transfer was also reviewed. RESULTS Six patients met inclusion criteria for retrospective review. None suffered intraoperative or postoperative inpatient complications and all were discharged within 72 h postoperatively. There were no flap failures within 30 d of reconstruction. CONCLUSION This study reviews a patient cohort undergoing free tissue transfer during the COVID-19 pandemic. These cases were reviewed for factors that may have contributed to their postoperative success after discharge within 72 hours. These data points were combined with published evidence on risks for failure after free flap reconstruction to design a protocol to select patients for early discharge. The benefits of early discharge include reducing healthcare costs, risks of inpatient hospitalization, and ICU utilization, which is of paramount importance in the midst of a global pandemic..
新冠肺炎大流行期间的自由组织转移:一种基于证据的早期出院方案
背景:随着游离组织移植效果的改善,各机构正在研究早期出院方案。“早期”通常定义为术后1 - 5天,这与大多数主要并发症的发生时间和皮瓣保留的机会有关。考虑到病毒大流行期间提前出院的趋势、降低医疗成本的需要和ICU床位的短缺,我们旨在提出一种基于证据的方案,选择在自由组织移植后72小时内出院的患者。方法回顾性分析自2019冠状病毒病(2020-2021)大流行开始以来,在美国田纳西州范德比尔特大学医学中心接受游离组织移植的所有患者。如果患者在手术后72小时内出院,则纳入审查。我们也回顾了有关自由组织移植后加速出院的文献。结果6例患者符合回顾性分析纳入标准。所有患者均无术中或术后住院并发症,术后72 h内出院。皮瓣重建30 d内未见缺损。结论:本研究回顾了在COVID-19大流行期间进行游离组织移植的患者队列。这些病例在出院后72小时内回顾了可能有助于其术后成功的因素。这些数据点与已发表的关于游离皮瓣重建失败风险的证据相结合,以设计一种方案来选择早期出院的患者。提前出院的好处包括降低医疗费用、住院风险和ICU使用率,这在全球大流行期间至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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11.10%
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41
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