(0617) Characteristics of Patients Requiring Prolonged Mechanical Ventilation Following Head and Neck Microvascular Reconstructive Procedures

Introduction: Head and neck surgeries with free tissue transfer represent major surgical endeavors that are often performed in patients with significant comorbidities. Postoperative failure to wean from ventilator support can be associated with poor patient outcomes. There is a paucity of literature exploring the impact of this. Here we utilize the National Surgical Quality Improvement Program (NSQIP) to better characterize these patients.

Methods: We identified patients from NSQIP who underwent major head and neck surgery with free flap reconstruction between the years of 2016 – 2020 using CPT codes. Patients were separated into cohorts based on prolonged mechanical ventilation (failure to wean) and a control group. Using R Studio, statistical analysis was performed including hypothesis testing as well as univariate regression. Subsequently, a multivariate regression model was used to verify these results and eliminate confounders.

Results: In total, 4,661 patients were included for analysis. Of them, 180 fell into the failure to wean cohort. While certain comorbidities such as diabetes, hypertension, and COPD were significant in the univariate analysis, multivariate analysis was unable to verify these results. However, mean operating time was longer in the failure to wean cohort by 83 minutes (p < 0.001). The outcomes of the two cohorts also diverged. Length of stay >30 days was significantly greater in the failure to wean cohort; 18.9% of patients in the failure to wean cohort versus 2.7% in the control (p < 0.001). Mean length of hospital stay was 20.65 days in the failure to wean cohort versus 10.68 days in the control (p < 0.001). The 30-day mortality was also significantly greater in the failure to wean cohort, 6.7% vs 1.1% (p < 0.001).

Conclusions: Enhanced recovery protocols have aimed to improve outcomes and reduce length of stay in patients undergoing major head and neck surgery. Our findings suggest that prolonged mechanical ventilation can also significantly affect these outcomes. Patients with prolonged mechanical ventilation have longer operations, longer time spent in the hospital, and increased 30-day mortality.