Critical care for the severely ill head and neck patient

Objective: To delineate the frequency and causes of admission to a critical care environment for patients undergoing head and neck surgery at Memorial Sloan-Kettering Cancer Center. Design: Retrospective clinical investigation. Setting: Adult intensive care unit of a tertiary referral cancer center. Patients: All head and neck surgery patients admitted to the special care u nit (SCU) of Memorial Sloan-Kettering Cancer Center between January 1, 1994 and December 31, 1995 were included in this study. Interventions: None. Measurements and Main Results: The data collected included demographic, ope rative procedures, clinical, laboratory, and physiologic variables at time of SCU admission, at 24 hrs, as well as vital status at the time of dischar ge from the SCU and hospital. Other data collected were the need for mechan ical ventilation and inotropic agents. During the period of January 1, 1994 through December 31, 1995, 37 (1.5%) of 2,346 patients undergoing head and neck surgical procedures required admission to the SCU. During the same pe riod, six patients receiving medical treatment only for head and neck malig nant disease were transferred to the SCU. These 43 admissions served as the basis for the study. The causes of admission to the SCU were pulmonary (15 /43), cardiac (14/43), wound related (8/43), and other (15/43). The median length of stay in the SCU was 2 days, and the median hospitalization for pa tients requiring critical care services was 22 days. Seventy four percent o f patients requiring critical care services were eventually discharged to h ome. Conclusions: Current preoperative evaluation, operative and anesthetic tech niques, and perioperative care result in a low frequency of utilization of critical care services by patients undergoing head and neck surgery. There is no single identifiable cause of complications for patients after head an d neck surgery leading to utilization of critical care services.