Document Detail

Postoperative monitoring in free tissue transfer patients: effective use of nursing and resident staff.
MedLine Citation:
PMID:  19861201     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To compare the outcomes of two different free flap monitoring protocols and determine whether nursing staff can safely and effectively monitor free flaps. STUDY DESIGN: Historical cohort study on all head and neck free tissue transfer patients from August 2003 to August 2007. SETTING: Tertiary care teaching institution. SUBJECTS AND METHODS: The patients were divided into two groups according to monitoring protocol. Group A (n = 49) had free flaps monitored primarily by resident physicians, while Group B patients (n = 45) were evaluated primarily by nursing staff. Demographic and outcomes data, including complications, reoperations, length of hospital stay, and flap viability, were then compared. RESULTS: Overall, 28 (57%) patients in Group A and 16 (37%) in Group B had at least one complication (P = 0.05). Only eight patients in each group had major complications. There were 25 (27%) patients who required further intervention in the operating room: 18 (37%) in Group A and seven (16%) in Group B (P = 0.03). Only 12 (13%) patients returned to the operating room for concerns of flap viability: seven from Group A and five from Group B. The median length of hospital stay was 11 days for both groups (P = 0.76). The flap success rate was 95 percent, with three failures in Group A and two in Group B (P = 0.72). CONCLUSIONS: A monitoring protocol utilizing trained nursing staff has no detrimental effect on free tissue transfer outcomes. This may be used to optimize resident time within the current duty-hour restrictions.
Ryan S Jackson; Ronald J Walker; Mark A Varvares; Michael J Odell
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-09-06
Journal Detail:
Title:  Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery     Volume:  141     ISSN:  1097-6817     ISO Abbreviation:  Otolaryngol Head Neck Surg     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-28     Completed Date:  2009-11-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8508176     Medline TA:  Otolaryngol Head Neck Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  621-5     Citation Subset:  IM    
Saint Louis University School of Medicine, Saint Louis, MO, USA.
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MeSH Terms
Internship and Residency*
Length of Stay
Middle Aged
Monitoring, Physiologic / methods*
Nursing Staff, Hospital / utilization*
Postoperative Care / methods*
Surgical Flaps*
Treatment Outcome

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