{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:29:24Z","timestamp":1786969764266,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"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."],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Study Design<\/jats:title>\n Retrospective review of 626 head and neck microvascular free flap (MVFF) cases from August 2019 to May 2024.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n University of Pittsburgh Medical Center.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Main outcome measure was HUM, calculated as total length of stay (TLOS) (TLOS\u2009=\u2009[PLOS\u2009+\u2009RLOS]\/60 days). High HUM, determined by median split, was >0.18.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Our 626\u2010patient cohort averaged 62.7\u2009\u00b1\u200911.9 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\u201014), median (IQR) HUM was 0.18 (0.13\u20100.28), and the rate of 60\u2010day re\u2010presentation\/readmission was 34.3%. Multivariable logistic regression identified postoperative complications (\n \u03b2<\/jats:italic>\n : .08,\n P<\/jats:italic>\n \u2009<\u2009.001;\n \u03b2<\/jats:italic>\n : 4.44,\n P<\/jats:italic>\n \u2009<\u2009.001, respectively) and private insurance (\n \u03b2<\/jats:italic>\n : \u2212.04,\n P<\/jats:italic>\n \u2009<\u2009.02; \u22122.71,\n P<\/jats:italic>\n \u2009<\u2009.01) as predictive factors associated with both higher HUM and PLOS (>9 days), respectively. Return to intensive care unit (ICU) (\n \u03b2<\/jats:italic>\n : .08,\n P<\/jats:italic>\n \u2009<\u2009.003) and duration of surgery (\n \u03b2<\/jats:italic>\n : .005,\n P<\/jats:italic>\n \u2009<\u2009.048) were independently associated with higher HUM, although both effect sizes are relatively small. Kaplan\u2010Meier survival curves revealed that higher HUM (\n P<\/jats:italic>\n \u2009=\u2009.030) but not PLOS (\n P<\/jats:italic>\n \u2009=\u2009.098) was associated with worse survival 1 year postoperatively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n HUM provides a comprehensive assessment of healthcare utilization compared to PLOS and re\u2010presentation alone and may be a practical surrogate for patient QOL and healthcare costs.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ohn.70377","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:17:18Z","timestamp":1786969038000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospitalization Utilization Metric After Major Oncologic Head and Neck Surgery With Microvascular Free Flap"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1932-5390","authenticated-orcid":false,"given":"Nana\u2010Hawwa","family":"Abdul\u2010Rahman","sequence":"first","affiliation":[{"name":"University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Tang","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Balogun","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandria","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6049-1508","authenticated-orcid":false,"given":"Shaum","family":"Sridharan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Spector","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8920-4522","authenticated-orcid":false,"given":"Carl H.","family":"Snyderman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine Pittsburgh Pennsylvania 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