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Arch Otolaryngol Head Neck Surg. 2004 Jun;130(6):779-85.

Comparing microvascular outcomes at a large integrated health maintenance organization with flagship centers in the United States.

Author information

1
Microvascular Reconstructive Head and Neck Surgery Service, Regional Head, Neck, and Skullbase Surgical Oncology Center, Southern California Permanente Medical Group, Los Angeles, USA. edgar.a.lueg@kp.org

Abstract

OBJECTIVE:

To determine if patients undergoing microvascular reconstructive head and neck surgery (MRHNS) at a large integrated health maintenance organization can expect outcomes similar to some of the best or flagship centers in the United States.

DESIGN:

Outcomes (flap loss, mortality, length of stay), eligibility (recent consecutive US center experience), high-experience (100 cases), high-volume (26 cases per year), and flagship criteria were prospectively defined. A systematic MEDLINE search identified 17 eligible reports. Independent, blinded medical reviewers identified 5 centers (29%) as flagship centers.

PATIENTS:

The first 116 consecutive patients (average, 39 cases per year) who underwent MRHNS on this service.

RESULTS:

All 5 flagship centers are major academic health centers ranked in the top 18 "best head and neck hospitals" in the United States. Flap loss (1.7% vs 4.4% for flagship centers; range, 0.9%-8.8%) and mortality (2.6% vs 2.8% for flagship centers; range, 0.5%-6.3%) rates were not significantly different. Although lengths of stay in flagship centers were similar to each other and the literature (mean, 21.4 days; range, 20.1-22.5 days), our length of stay was significantly shorter (8.8 days, P<.001).

CONCLUSION:

For high-experience and high-volume centers, patients undergoing MRHNS at a large integrated health maintenance organization can expect morbidity and mortality outcomes similar to flagship centers in the United States, with shorter hospitalizations.

PMID:
15210563
DOI:
10.1001/archotol.130.6.779
[Indexed for MEDLINE]

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