Study of the length of hospital stay for free flap reconstruction of oral and pharyngeal cancer in the context of the new French casemix-based funding

• Published in: Oral oncology 2010-03, Vol.46 (3), p.190-194
• Main Authors: Girod, Angélique, Brancati, Antonio, Mosseri, Véronique, Kriegel, Irène, Jouffroy, Thomas, Rodriguez, José
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - surgery; Casemix-based funding; Child; Diagnosis-Related Groups; Female; France - epidemiology; Free flap; Graft Survival; Head and Neck Neoplasms - epidemiology; Head and Neck Neoplasms - surgery; Hematology, Oncology and Palliative Medicine; Humans; Length of hospital stay; Length of Stay - economics; Male; Medical sciences; Middle Aged; National Health Programs - economics; Oral cancer; Otolaryngology; Otorhinolaryngology. Stomatology; Postoperative Complications; Prospective Studies; Reconstruction; Reconstructive Surgical Procedures - economics; Reconstructive Surgical Procedures - methods; Surgical Flaps - economics; Treatment Outcome; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Young Adult
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2009.12.002

Summary The French national health insurance reimbursement system has recently changed from a global hospital funding system to casemix-based funding. The authors studied the factors likely to influence the length of hospital stay for free flap reconstructions after surgery for cancers of the oral cavity or pharynx. Data concerning 207 oral cavity or pharynx free flap reconstructions were extracted from a prospective registration. Lengths of hospital stay were compared by an analysis of variance F test or a nonparametric Kruskal–Wallis test, and transfusion rates were compared by Chi-square test or Fisher’s exact test, as appropriate. The median length of hospital stay was 24 days (range: 7–145 days). Length of hospital stay was significantly longer according to the type of flap ( p < 0.005), in N2–N3 patients ( p < 0.02), a PINI score more than 10, a 3–4 American Society of Anesthesiologists (ASA) score, the presence of a tracheotomy and in patients requiring transfusion ( p < 0.0001). As the nodal status, the American Society of Anesthesiologists (ASA) score of the patient, the need of tracheotomy and the type of flap cannot be corrected, the management of preoperative haemoglobin and nutritional status are the sole factors which can improve the length of hospital stay. In the context of the new casemix-based funding, this study raises the problem of harvesting of the fibula flap, management of preoperative haemoglobin and nutritional status.