Value of General Ward-Based Postoperative Management for Microvascular Free Flap Reconstruction in Head and Neck Surgery: Comparable Outcomes

Background and Objectives Intensive care unit (ICU) admission after microvascular free flap transfer is common in head and neck surgery, but routine ICU care may increase complications and costs. We compared the treatment outcomes of patients managed in a general ward (GW) and those managed in the ICU.Subjects and Method We retrospectively reviewed adults who underwent vascularized free tissue transfer at a single center between January 2019 and December 2024. Patients followed either GW- or ICU-based postoperative protocols. Demographic, surgical, and postoperative data were collected. Trends in body temperature, pain, white blood cell count (WBC), and C-reactive protein (CRP) were analyzed using generalized estimating equations. Additional analyses adjusted for operation time were performed.Results A total of 73 patients were included (GW, n=10; ICU, n=63). The GW group had a shorter operative time (299.6±79.8 min vs. 478.9±126.5 min) and shorter hospital stay (16.5±9.0 days vs. 25.9±24.2 days) than the ICU group. Flap failure and fistula formation did not differ significantly between groups. In the unadjusted analyses, WBC and CRP showed more favorable trends in the GW group. After adjustment for operation time, differences in body temperature and pain were attenuated, whereas differences in WBC and CRP remained significant; operation time itself was associated with CRP.Conclusion GW-based postoperative management was not associated with worse flap-related outcomes than routine ICU care in the selected patients. Although operative duration accounted for part of the between-group differences, more favorable inflammatory trends remained in the GW group after adjustment for operation time.