{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:04:15Z","timestamp":1790247855102,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to evaluate whether perioperative care improves postoperative outcomes for head and neck reconstruction patients with preexisting health conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Single tertiary academic center between 2013 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included adult patients who underwent free\u2010flap reconstruction for head and neck cancer. Patients who received perioperative care were compared with patients who received our institution's standard of care. Comorbid health conditions were measured using the Charlson comorbidity index (CCI) excluding solid tumors. Primary outcomes were major and minor complications, length of hospital stay (LOS), days in intensive care unit (ICU), discharge to acute\/subacute facility, hospital\u2010free days, and overall survival (OS). Interaction models were specified to evaluate the impact of preoperative care with respect to CCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 148 patients included, 83 received perioperative care and 65 received institutional standard of care (mean [SD]: age, 62.1 [10.8]; male, 100 [67.6%]; CCI\u2009\u20094, 43 [29.1%]). Patients with higher CCI who received perioperative care spent fewer days in the hospital (CCI 3: coefficient [, \u22125.50;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.012 and CCI\u2009\u20094: , \u22126.41;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.022) and ICU (CCI 3: , \u22122.90;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002 and CCI\u2009\u20094: , \u22126.54;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.001), gained more hospital\u2010free days (CCI\u2009\u20094: , 17.00;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002), and had improved OS (CCI\u2009\u20094: adjusted hazard ratio [aHR], 0.14;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.023). Perioperative care was not significantly associated with lower rates of major and minor complications or placement at a facility.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Perioperative care provides a robust benefit for patients with medical comorbidities undergoing head and neck reconstruction, but this effect incrementally decreases for healthier patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.1373","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T06:25:55Z","timestamp":1754375155000},"page":"1121-1130","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative Care Clinic Improves Survival for Patients Undergoing Free\u2010Flap Reconstruction"],"prefix":"10.1002","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8519-5366","authenticated-orcid":false,"given":"Randall J.","family":"Harley","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Esper","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Center of Perioperative Care UPMC Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy Z.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery UPMC Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soukaina","family":"Eljamri","sequence":"additional","affiliation":[{"name":"School of Medicine University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preetha","family":"Velu","sequence":"additional","affiliation":[{"name":"School of Medicine University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario G.","family":"Solari","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery UPMC Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaum S.","family":"Sridharan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery UPMC Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Kubik","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery UPMC Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery UPMC Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.2981"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2016.09.025"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2016.01.009"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29828"},{"issue":"4","key":"e_1_2_8_6_1","first-page":"577","article-title":"Free flap head and neck reconstruction: feasibility in older patients","volume":"10","author":"Parsemain A","year":"2019","journal-title":"J 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