Association of a High-Intensity Postoperative Care Policy with Reoperation After Free Flap Reconstruction: A Single-Center Retrospective Cohort Study

Background/Objectives: The optimal postoperative setting after head and neck free-flap reconstruction remains uncertain. We evaluated the association between a policy establishing intensive care unit (ICU) management as standard practice and reoperation within 30 days. Methods: This single-center retrospective cohort study included adults undergoing free-flap reconstruction between January 2020 and December 2025. Patients were classified according to whether surgery occurred before or after policy implementation. The primary outcome was reoperation under general anesthesia within 30 days. Multivariable logistic regression included policy period, preoperative albumin level, and diabetes mellitus. Sensitivity analyses excluded five post-policy patients transferred to the general ward and those treated in 2022. Results: Among 254 patients, 103 were treated before and 151 after policy implementation. Reoperation was numerically less frequent after implementation (7.3% vs. 14.6%, p = 0.090). Policy implementation was independently associated with lower odds of reoperation (adjusted odds ratio [aOR], 0.31; 95% confidence interval [CI], 0.13–0.79; p = 0.013), with consistent findings in sensitivity analyses. Diabetes mellitus was independently associated with higher odds of reoperation (aOR, 3.72; 95% CI, 1.43–9.67; p = 0.007). Postoperative complications (31.8% vs. 19.4%, p = 0.031) and surgical site infections (19.2% vs. 6.8%, p = 0.006) were more frequently documented after implementation. Conclusions: In adjusted analyses, the post-ICU policy period was associated with lower odds of reoperation, although postoperative complications were more frequently documented. These findings may inform decisions regarding immediate postoperative care but do not establish that routine ICU admission is necessary or beneficial for all patients.