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Impact of Area Deprivation Index and Distance from Hospital on Outcomes in Free Tissue Transfer Patients
Pooja Humar, BS; Elizabeth A. Moroni MD, MHA; Lauren Gardiner, MD; Fuat Baris Bengur, MD; Mario G. Solari, MD; Shaum S. Sridharan, MD; Mark Kubik, MD.
University of Pittsburgh Medical Center
2023-01-31
Presenter: Pooja Humar
Affidavit:
All work on this project represents the original work of the included authors
Director Name: J. Peter Rubin
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Low socioeconomic status (SES) is a known risk factor for head and neck cancer or trauma but the impact of neighborhood-level factors on free tissue transfer (FTT) outcomes after reconstruction is not well described. This study examines the association of Area Deprivation Index (ADI), a metric of neighborhood disadvantage, with outcomes after FTT.
Methods: A single-center retrospective review was performed of all patients undergoing FTT for head and neck reconstruction from October 2019-February 2022. Primary outcomes were re-admission and re-intervention. Secondary outcomes include post-operative complications and length of stay.
Results: 360 patients with FTT for head and neck reconstruction for malignancy or trauma were included. The average length of stay was 10.5 days (SD 6.3 days). Patients discharged within 4 days had a significantly lower ADI than those discharged after 14 days (60.9 vs. 68.7, p<0.05). Patients discharged to SNF had a significantly higher ADI than patients discharged to home either with or without nursing (72.7 vs. 65.6, p<0.05). 141 patients (37%) had a post-operative complication. 26 patients (7.2%) were re-admitted after index hospital stay. These patients had a significantly higher ADI than those with no re-admission history (p<0.05) but no difference in distance from hospital. 5% of patients had a re-intervention, but no difference in ADI from those without re-intervention.
Conclusion: Measures of neighborhood deprivation can be a helpful tool to identify higher risk individuals and better allocate resources to mitigate risk of mortality and complications, particularly in smaller centers with less developed preoperative and postoperative support capabilities.
