IMPORTANCE: A patient's needs at discharge, particularly the need for nursing facility placement, may affect hospital length of stay and health care costs. The association between age and disposition after microvascular reconstruction of the head and neck has yet to be reported in the literature. OBJECTIVE: To determine whether elderly patients are more likely to be discharged to a nursing or other care facility as opposed to returning home after microvascular reconstruction of the head and neck. DESIGN, SETTING, AND PARTICIPANTS: From January 1, 2001, through December 31, 2010, patients undergoing microvascular reconstruction at an academic medical center were identified and their medical records systematically reviewed. During the study period, 457 patients were identified by Current Procedural Terminology codes for microvascular free tissue transfer for a head and neck defect regardless of cause. Seven patients were excluded for inadequate data on the postoperative disposition or American Society of Anesthesiologists (ASA) score. A total of 450 were included for analysis. MAIN OUTCOMES AND MEASURES: Demographic and surgical data were collected, including the patient age, ASA score, and postoperative length of stay. These variables were then compared between groups of patients discharged to different posthospitalization care facilities. RESULTS: The mean age of participants was 59.1 years. Most patients (n = 386 [85.8%]) were discharged home with or without home health services. The mean age of those discharged home was 57.5 years; discharge to home was the reference for comparison and odds ratio (OR) calculation. For those discharged to a skilled nursing facility, mean age was 67.1 years (OR, 1.055; P < .001). Mean age of those discharged to a long-term acute care facility was 71.5 years (OR, 1.092; P = .002). Length of stay also affected the disposition to a skilled nursing facility (OR, 1.098), as did the ASA score (OR, 2.988). CONCLUSIONS AND RELEVANCE: Elderly patients are less likely to be discharged home after free flap reconstruction. Age, ASA score, and length of stay are independent factors for discharge to a nursing or other care facility.
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机译：重要信息：病人出院时的需求，尤其是护理设施的放置，可能会影响住院时间和医疗保健费用。头颈部微血管重建后年龄与性格之间的关联尚未在文献中报道。目的：确定相对于头颈部微血管重建后返回家中，老年患者是否更可能出院到护理或其他护理机构。设计，地点和参与者：从2001年1月1日至2010年12月31日，在学术医疗中心对正在接受微血管重建的患者进行鉴定，并对其医疗记录进行系统地审查。在研究期间，通过现行程序术语法鉴定了457例患者，无论原因为何，均可以进行无头颈部微血管游离组织转移。由于术后处理或美国麻醉医师学会（ASA）评分方面的数据不足，排除了7名患者。总共包括450个进行分析。主要结果和措施：收集人口统计学和外科手术数据，包括患者年龄，ASA评分和术后住院时间。然后，将这些变量在不同住院治疗后出院的患者组之间进行比较。结果：参与者的平均年龄为59.1岁。大多数患者（n = 386 [85.8％]）在有或没有家庭保健服务的情况下出院回家。出院者的平均年龄为57.5岁;出院是比较和优势比（OR）计算的参考。对于出院到专业护理机构的患者，平均年龄为67.1岁（OR，1.055; P <.001）。出院进入长期急性护理机构的患者的平均年龄为71.5岁（OR，1.092; P = .002）。住院时间长短也影响到对熟练护理机构的安排（OR，1.098），ASA评分（OR，2.988）也是如此。结论和相关性：老年患者游离皮瓣重建后不太可能出院。年龄，ASA评分和住院时间是出院到护理或其他护理机构的独立因素。
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