Hospitalization Utilization Metric After Major Oncologic Head and Neck Surgery With Microvascular Free Flap

OBJECTIVE: The primary length of stay (PLOS) metric fails to capture added time, costs, and reduced patient quality of life (QOL) associated with readmissions. To address these limitations, we propose a novel metric, the hospitalization utilization metric (HUM), which integrates PLOS and readmission LOS (RLOS). STUDY DESIGN: Retrospective review of 626 head and neck microvascular free flap (MVFF) cases from August 2019 to May 2024. SETTING: University of Pittsburgh Medical Center. METHODS: Main outcome measure was HUM, calculated as total length of stay (TLOS) (TLOS = [PLOS + RLOS]/60 days). High HUM, determined by median split, was >0.18. RESULTS: Our 626-patient cohort averaged 62.7 ± 11.9 years old. The majority of patients were male (68.2%), white (92.0%), with advanced tumors (III/IV: 74.1%), and public insurance (63.1%). The median (interquartile range [IQR]) PLOS was 9 (7-14), median (IQR) HUM was 0.18 (0.13-0.28), and the rate of 60-day re-presentation/readmission was 34.3%. Multivariable logistic regression identified postoperative complications (β: .08, P < .001; β: 4.44, P < .001, respectively) and private insurance (β: -.04, P < .02; -2.71, P < .01) as predictive factors associated with both higher HUM and PLOS (>9 days), respectively. Return to intensive care unit (ICU) (β: .08, P < .003) and duration of surgery (β: .005, P < .048) were independently associated with higher HUM, although both effect sizes are relatively small. Kaplan-Meier survival curves revealed that higher HUM (P = .030) but not PLOS (P = .098) was associated with worse survival 1 year postoperatively. CONCLUSION: HUM provides a comprehensive assessment of healthcare utilization compared to PLOS and re-presentation alone and may be a practical surrogate for patient QOL and healthcare costs.