Early Weight-Bearing After Fibula Free Flap Surgery
Importance: Despite the widespread use of fibula free flap (FFF) surgery for head and neck reconstruction, there are no studies assessing if early weight-bearing (EWB) affects postoperative recovery, and the timing of weight-bearing initiation following FFF surgery varies considerably across institutions. Therefore, it is important to understand the effect of EWB in these patients and whether it could improve postoperative recovery.
Objective: To assess the association of EWB after FFF surgery with donor-site complications, length of stay, and discharge to home status.
Design, Setting, and Participants: This retrospective cohort study took place at Massachusetts Eye and Ear, a single tertiary care institution in Boston, Massachusetts. A total of 152 patients who received head and neck reconstruction with a fibula osteocutaneous free flap between January 11, 2010, and August 11, 2022, were included.
Exposure: EWB on postoperative day 1 vs non-EWB on postoperative day 2 or later.
Main Outcomes and Measures: Patient characteristics, including demographic characteristics and comorbidities, surgical characteristics, donor-site complications, length of stay, and discharge disposition, were recorded. Descriptive statistics and multivariate logistic regressions were used to compute effect sizes and 95% CIs to compare postoperative outcomes in EWB and non-EWB groups.
Results: A total of 152 patients (median [IQR] age, 63 [55-70] years; 89 [58.6%] male) were included. The median (IQR) time to postoperative weight-bearing was 3 (1-5) days. Among all patients, 14 (9.2%) had donor-site complications. EWB on postoperative day 1 was associated with shorter length of stay (adjusted odds ratio [AOR], 0.10; 95% CI, 0.02-0.60), increased rate of discharge to home (AOR, 7.43; 95% CI, 2.23-24.80), and decreased donor-site complications (AOR, 0.11; 95% CI, 0.01-0.94). Conversely, weight-bearing 3 or more days postoperatively was associated with an increased risk of pneumonia (AOR, 6.82; 95% CI, 1.33-34.99).
Conclusions and Relevance: In this cohort study, EWB after FFF surgery was associated with shorter length of stay, increased rate of discharge to home, and decreased donor-site complications. These findings support the role of early mobilization to optimize postoperative recovery after FFF surgery.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:150 |
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| Enthalten in: |
JAMA otolaryngology-- head & neck surgery - 150(2024), 2 vom: 01. Feb., Seite 127-132 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kim, Minjee [VerfasserIn] |
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| Anmerkungen: |
Date Completed 09.02.2024 Date Revised 11.02.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1001/jamaoto.2023.4024 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Importance: Despite the widespread use of fibula free flap (FFF) surgery for head and neck reconstruction, there are no studies assessing if early weight-bearing (EWB) affects postoperative recovery, and the timing of weight-bearing initiation following FFF surgery varies considerably across institutions. Therefore, it is important to understand the effect of EWB in these patients and whether it could improve postoperative recovery | ||
| 520 | |a Objective: To assess the association of EWB after FFF surgery with donor-site complications, length of stay, and discharge to home status | ||
| 520 | |a Design, Setting, and Participants: This retrospective cohort study took place at Massachusetts Eye and Ear, a single tertiary care institution in Boston, Massachusetts. A total of 152 patients who received head and neck reconstruction with a fibula osteocutaneous free flap between January 11, 2010, and August 11, 2022, were included | ||
| 520 | |a Exposure: EWB on postoperative day 1 vs non-EWB on postoperative day 2 or later | ||
| 520 | |a Main Outcomes and Measures: Patient characteristics, including demographic characteristics and comorbidities, surgical characteristics, donor-site complications, length of stay, and discharge disposition, were recorded. Descriptive statistics and multivariate logistic regressions were used to compute effect sizes and 95% CIs to compare postoperative outcomes in EWB and non-EWB groups | ||
| 520 | |a Results: A total of 152 patients (median [IQR] age, 63 [55-70] years; 89 [58.6%] male) were included. The median (IQR) time to postoperative weight-bearing was 3 (1-5) days. Among all patients, 14 (9.2%) had donor-site complications. EWB on postoperative day 1 was associated with shorter length of stay (adjusted odds ratio [AOR], 0.10; 95% CI, 0.02-0.60), increased rate of discharge to home (AOR, 7.43; 95% CI, 2.23-24.80), and decreased donor-site complications (AOR, 0.11; 95% CI, 0.01-0.94). Conversely, weight-bearing 3 or more days postoperatively was associated with an increased risk of pneumonia (AOR, 6.82; 95% CI, 1.33-34.99) | ||
| 520 | |a Conclusions and Relevance: In this cohort study, EWB after FFF surgery was associated with shorter length of stay, increased rate of discharge to home, and decreased donor-site complications. These findings support the role of early mobilization to optimize postoperative recovery after FFF surgery | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Wu, Michael P |e verfasserin |4 aut | |
| 700 | 1 | |a Miller, Lauren E |e verfasserin |4 aut | |
| 700 | 1 | |a Meyer, Charles D |e verfasserin |4 aut | |
| 700 | 1 | |a Feng, Allen L |e verfasserin |4 aut | |
| 700 | 1 | |a Varvares, Mark A |e verfasserin |4 aut | |
| 700 | 1 | |a Deschler, Daniel G |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Derrick T |e verfasserin |4 aut | |
| 700 | 1 | |a Richmon, Jeremy D |e verfasserin |4 aut | |
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