The Importance and Challenges of a Specialty-Specific National Surgical Quality Improvement Program for Head and Neck Surgery

2016 ◽  
Vol 142 (4) ◽  
pp. 328 ◽  
Author(s):  
Jonathan Irish ◽  
Antoine Eskander
Keyword(s):  
Quality Improvement ◽  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality

Sequelae of Index Complications following Inpatient Head and Neck Surgery: Characterizing Secondary Complications

2018 ◽  
Vol 159 (2) ◽  
pp. 274-282 ◽  
Author(s):  
Alexander N. Goel ◽  
Karam W. Badran ◽  
Alexander M. Garrett ◽  
Maie A. St. John ◽  
Jennifer L. Long
Keyword(s):  
Head And Neck ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Improvement Program ◽  
Secondary Complications ◽  
Surgical Quality ◽  
Ventilatory Failure ◽  
Complications And Mortality

Objective To characterize patterns of secondary complications after inpatient head and neck surgery. Study Design Retrospective cohort study. Setting National Surgical Quality Improvement Program (2005-2015). Subjects and Methods We identified 18,584 patients who underwent inpatient otolaryngologic surgery. Four index complications were studied: pneumonia, bleeding or transfusion event (BTE), deep/organ space surgical site infection (SSI), and myocardial infarction (MI). Each patient with an index complication was matched to a control patient based on propensity for the index event and event-free days. Rates of 30-day secondary complications and mortality were compared. Results Index pneumonia (n = 254) was associated with several complications, including reintubation (odds ratio [OR], 11.7; 95% confidence interval [CI], 5.2-26.4), sepsis (OR, 8.8; 95% CI, 4.5-17.2), and death (OR, 5.3; 95% CI, 1.9-14.9). Index MI (n = 50) was associated with increased odds of reintubation (OR, 17.2; 95% CI, 3.5-84.1), ventilatory failure (OR, 5.8; 95% CI, 1.8-19.1), and death (OR, 24.8; 95% CI, 2.9-211.4). Index deep/organ space SSI (n = 271) was associated with dehiscence (OR, 7.2; 95% CI, 3.6-14.2) and sepsis (OR, 38.3; 95% CI, 11.6-126.4). Index BTE (n = 1009) increased the odds of cardiac arrest (OR, 3.9; 95% CI, 1.8-8.5) and death (OR, 2.9; 95% CI, 1.6-5.1). Conclusions Our study is the first to quantify the effect of index complications on the risk of specific secondary complications following inpatient head and neck surgery. These associations may be used to identify patients most at risk postoperatively and target specific interventions aimed to prevent or interrupt further complications.

Complications Associated with Mortality after Head and Neck Surgery: An Analysis of the NSQIP Database

2017 ◽  
Vol 156 (3) ◽  
pp. 504-510 ◽  
Author(s):  
Carolyn L. Mulvey ◽  
Jason A. Brant ◽  
Andrés M. Bur ◽  
Jinbo Chen ◽  
John P. Fischer ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
National Database ◽  
Multivariate Logistic Regression ◽  
Improvement Program ◽  
Surgical Quality ◽  
Increased Risk ◽  
American College Of Surgeons ◽  
Progressive Renal Insufficiency

Objective To determine which complications, as defined by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, correlate with 30-day mortality in surgery for malignancies of the head and neck. Study Design Retrospective review of prospectively collected national database. Setting NSQIP. Subjects and Methods NSQIP data from 2005 to 2014 were queried for ICD-9 codes head and neck malignancies. Multivariate logistic regression was used to examine the correlation of individual complications with 30-day mortality. Results In total, 15,410 cases met criteria with 3499 complications in 2235 cases. After controlling for patient and surgical variables, postoperative pneumonia ( P = .02; odds ratio [OR], 2.39; 95% confidence interval [CI], 1.15-4.72), progressive renal insufficiency ( P < .001; OR, 21.28; 95% CI, 4.22-87.94), bleeding requiring transfusion ( P = .02; OR, 2.10; 95% CI, 1.12-3.84), sepsis ( P = .02; OR, 2.86; 95% CI, 1.15-6.46), septic shock ( P = .045; OR, 2.87; 95% CI, 0.98-7.81), stroke ( P < .001; OR, 19.81; 95% CI, 6.23-56.03), and cardiac arrest ( P < .001; OR, 135.59; 95% CI, 65.00-286.48) were independently associated with increased odds of 30-day mortality. Conclusion The NSQIP database has been extensively validated and used to examine surgical complications, yet there is little analysis on which complications are associated with death. This study identified complications associated with increased risk of 30-day mortality following head and neck cancer surgery. These associations may be used as a measure of complication severity and should be considered when using the NSQIP database to evaluate outcomes in head and neck surgery.

National Database Research in Head and Neck Reconstructive Surgery: A Call for Increased Transparency and Reproducibility

2020 ◽  
pp. 019459982093804
Author(s):  
Andrés M. Bur ◽  
Mark R. Villwock ◽  
Rohit Nallani ◽  
Ernest D. Gomez ◽  
Mark A. Varvares ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Head And Neck ◽  
Plastic Surgery ◽  
Free Tissue Transfer ◽  
Quality Improvement Program ◽  
National Database ◽  
Improvement Program ◽  
Surgical Quality ◽  
Case Selection ◽  
Tissue Transfer

Objective To reproduce a published study comparing outcomes of patients who underwent microvascular reconstruction by plastic surgeons and otolaryngologists and to examine how case selection and methodology using the National Surgical Quality Improvement Program (NSQIP) data set can affect results and conclusions. Study Design Cross-sectional analysis of US national database. Setting American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2005 to 2017. Subjects and Methods A recently published study that used the NSQIP database to compare outcomes after head and neck free tissue transfer between plastic surgeons and otolaryngologists was reproduced. Different approaches to case selection and statistical analysis were evaluated and their effects on statistical significance and study conclusions were compared. Results When all cases of free tissue transfer, captured in NSQIP between 2005 and 2017, were compared between plastic surgery and otolaryngology, plastic surgery patients appeared to have lower rates of complications and length of stay. However, a more in-depth analysis demonstrated that these results were confounded by older and sicker otolaryngology patients. A second analysis of the same NSQIP data, limited to only head and neck oncologic reconstructions, demonstrated that otolaryngology patients had fewer complications on univariate and multivariable analysis. Conclusion We demonstrated how case selection and analysis can significantly affect results. It is incumbent upon researchers who use NSQIP and other publicly available data sets to fully detail their methodology to allow other researchers to reproduce and evaluate their work and for the journal editorial process to carefully evaluate the methodology and conclusions of their contributing authors.

Long-term Trends in Head and Neck Surgery Outcomes

2018 ◽  
Vol 159 (6) ◽  
pp. 1012-1019
Author(s):  
Alia Mowery ◽  
Tyler Light ◽  
Daniel Clayburgh
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Veterans Affairs ◽  
Head And Neck Surgery ◽  
Morbidity And Mortality ◽  
Complication Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Long Term Trends

Objective The aim of the present study is to address the paucity of data on long-term trends in postoperative complication rates in head and neck surgery. Specifically, this study assesses trends in morbidity and mortality following head and neck surgery over a 20-year period from 1995 to 2015 and identifies risk factors for the development of complications. Study Design Retrospective cross-sectional analysis of Veterans Affairs Surgical Quality Improvement Program database from 1995 to 2015. Setting Veterans Affairs medical centers across the United States. Subjects and Methods Using the Veterans Affairs Surgical Quality Improvement Program database, we selected 44,161 patients undergoing head and neck procedures from 1995 to 2015. Trends in 30-day morbidity and mortality were assessed, and univariate and multivariate analyses of risk factors for complications were performed. Results From 1995-2000 to 2011-2015, overall complication rates decreased >45% (from 10.9% to 5.9%), and 30-day postsurgical mortality decreased nearly 70% (from 1.3% to 0.4%). Postoperative hospital stays also significantly declined. Major procedures, such as free flap cases and total laryngectomies, had less change in complication rate as compared with less invasive procedures. Conclusion Substantial improvement in postoperative morbidity and mortality has taken place in head and neck surgery over the past decades. Static complication rates in some procedures may reflect that the improvement of surgical techniques allow for the treatment of sicker patients. The trends seen in this study speak to the importance of probing further why high rates of complications are still seen in certain procedures and ensuring that effective treatment is balanced with limiting morbidity and mortality.

Sign in / Sign up

Export Citation Format

Share Document