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acute medical issues and/or complications have resolved or stabilized, allowing them to meet the physical therapy/occupational therapy criteria for discharge home or to a facility. Furthermore, the free ap monitoring has been completed, which is a surgeon-specic variable. In a study conducted by the University of Florida, it was agreed that external aps should be monitored for 5days and internal buried aps for 7days. Ancillary services assessed the patient/caregiver’s ability to perform self-care, such as feeding, airway management (e.g., tracheostomy care), mobility at home, self­hygiene, and wound care; their ndings revealed that 65% of patients experienced a delay in dis­charge (DC) with a mean of 4.8days, resulting in an overall length of stay (LOS) of 13.1days. This delay in discharge could be attributed to the age of the patients, as older patients are more likely to experience delays in discharge [4]. Social factors were strongly associated with DC delays. For instance, patients with children were 1.8 times less likely to experience a delay in discharge than those without children, likely due to the presence of adult children providing support after dis­charge. Additionally, those with dependents were more likely to be discharged to their home envi­ronment with familial assistance. The patient’s insurance status had a signicant inuence on the discharge plan; those with Medicaid or self-pay were 4.4 times more likely to experience a delay in discharge, particularly if they were discharged to a facility other than home. As many destina­tions were unlikely to accept Medicaid or lower tier insurances, discharge options were limited such as intermediate care and skilled nursing facilities (SNFs), inpatient rehabilitation, and long-term acute care hospital (LTACH) [1, 5]. Insurance status was found to be a complicating factor across various surgical specialties, not only limited to head and neck cancer and microvascu­lar reconstruction patients. Upon further analysis, the delay was due to a shortage of beds in the facility, the absence of an accepting facility, trans­portation, and other social obstacles [6]. Other factors that have been linked to an increase in the LOS specic to head and neck surgery are poor functional status, excessive consumption of alco­hol, other associated medical comorbidities, oper-

ative time exceeding 8 h, need for blood transfusion, wound types, and history of radiation therapy [7]. The size of the case managers and social worker teams can contribute to delays in discharge. In some hospitals, head and neck oncology patients may have to share case manag­ers and social workers with other surgical patients; the discharge process can be delayed, particularly when discharges are planned on Mondays and Fridays with a rotating case manager, as handoff delays become more likely.

Efciency in the discharge process is becoming an important quality metric for assessing the planning and coordination between the surgical team and other teams. Head and neck cancer patients have been known to experience delays in discharge, which has prompted us to identify and address these issues to ensure an early and safe discharge process.