000			03562nam a22004097a 4500
008			220926s20222022 xxu||||| |||| 00| 0 eng d
022			_a0738-1085
024			_a10.1002/micr.30935 [doi]
040			_aOvid MEDLINE(R)
099			_a35792568
245			_aIntensive care unit versus floor admission following lower extremity free flap surgery: Is there a difference in outcomes?.
251			_aMicrosurgery. 2022 Jul 06
252			_aMicrosurgery. 2022 Jul 06
253			_aMicrosurgery
260			_c2022
260			_fFY2023
260			_p2022 Jul 06
265			_saheadofprint
266			_d2022-09-26
501			_aAvailable online from MWHC library: 1996 - 2002
520			_aBACKGROUND: Free tissue transfer (FTT) lower limb salvage requires costly multidisciplinary care. Traditionally, patients who undergo FTT reconstruction for lower extremity (LE) wounds were admitted to the intensive care unit (ICU) in the immediate postoperative period for close monitoring. During the COVID-19 pandemic, our practice shifted toward admitting FTT patients to the floor postoperatively instead of the ICU. The purpose of this study is to compare surgical outcomes in patients admitted to the floor versus ICU immediately following LE free flap reconstruction.
520			_aCONCLUSION: Our findings suggest that postoperative floor admission does not decrease flap success rates and should be considered in patients who undergo FTT to LE reconstruction and are otherwise stable. In the ongoing era of health care cost containment, microsurgery centers should consider appropriate floor training to allow medically stable free flap patients to avoid an ICU stay. Copyright © 2022 Wiley Periodicals LLC.
520			_aMETHODS: We retrospectively reviewed patients undergoing LE FTT reconstruction from 2011 to 2021. Flap monitoring consisted of an implantable Cook-Swartz Doppler probe for muscle flaps and ViOptix tissue oximetry for fasciocutaneous flaps; clinical exam and hand-held dopplers were not the primary flap monitoring techniques. Patients were divided into two groups depending on whether they went to the ICU or floor postoperatively. To ensure proper comparability between cohorts, we corrected for age, BMI and Charlson Comorbidity Index (CCI) using 1:2 propensity score matching (floor: ICU). Primary outcomes included early postoperative complications, flap takeback and salvage, flap success, and postoperative length of stay (LOS).
520			_aRESULTS: A total of 252 patients were identified. Forty-five patients (17.9%) were admitted to the floor postoperatively and 207 patients (82.1%) to the ICU. Overall, microsurgical success rate was 97.2%, which was similar for floor and ICU patients. Flap takeback and salvage were similar between cohorts. Average postoperative LOS was significantly shorter in floor patients (15.7 vs. 19.1 days, p = 0.043).
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Georgetown University Hospital/MedStar Washington Hospital Center
651			_aMedStar Washington Hospital Center
656			_aMedStar General Surgery Residency
656			_aSurgery/Plastic Surgery
657			_aJournal Article
700			_aDeldar, Romina _bMGUH _cMedStar General Surgery Residency _dMD _eResident PGY 4
700			_aFan, Kenneth L
790			_aAbu El Hawa AA, Bovill JD, Deldar R, Evans KK, Fan KL, Gupta N, Truong BN
856			_uhttps://dx.doi.org/10.1002/micr.30935 _zhttps://dx.doi.org/10.1002/micr.30935
942			_cART _dArticle
999			_c403 _d403