Patterns of disposition in patients following major head-and-neck reconstructive surgery – A hospital-based follow-up study

Abstract

Background: Disposition refers to the level of care, to which patients get discharged after surgery. Pre-operative physical status of patients and intraoperative adverse events may impact post-operative disposition of surgical patients. Aims and Objectives: We aimed to assess the nature of the disposition of patients 3 months after major head-and-neck reconstructive surgery. Effects of pre-operative status and perioperative adverse events on disposition patterns were also assessed. Materials and Methods: This prospective, observational study was conducted in 260 patients over 1.5 years at a tertiary care institute. Details of patients undergoing major head-and-neck reconstructive surgeries were noted and they were contacted over the telephone after 3 months of surgery. Results: Chi-square test and one-way ANOVA with post hoc Bonferroni test were used for analysis. Initially 260 patients were included in the study. But we lost follow-up of 45 patients. 65% of patients who were followed up (n = 139) were found to be in level 1 disposition at 3 months. Disposition to levels 2, 3, 4 and 5 was 14%, 6.5%, 6.5% and 8.4%, respectively. Hyponatraemia, intraoperative hypotension, need for blood transfusions and length of stay in the intensive care unit were found to have a significant effect on disposition patterns (P < 0.001) with worse levels of disposition. Perioperative hypoalbuminaemia and hypothermia also had similar trends, but they were not statistically significant. The majority (65%) of the patients got discharged home and the percentage mortality was low (8.4%) in the study population. Conclusion: Pre-operative status of the patient and the occurrence of perioperative adverse events had an impact on the nature of the disposition of patients after major head-and-neck reconstructive surgery.