Long-term Trends in Head and Neck Surgery Outcomes

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.

Download Full-text

Venous thromboembolism incidence in head and neck surgery patients: Analysis of the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database

Oral Oncology ◽

10.1016/j.oraloncology.2017.12.002 ◽

2018 ◽

Vol 77 ◽

pp. 22-28 ◽

Cited By ~ 6

Author(s):

Alia Mowery ◽

Tyler Light ◽

Daniel Clayburgh

Keyword(s):

Quality Improvement ◽

Venous Thromboembolism ◽

Head And Neck ◽

Neck Surgery ◽

Veterans Affairs ◽

Head And Neck Surgery ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality

Download Full-text

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

Otolaryngology ◽

10.1177/0194599818757960 ◽

2018 ◽

Vol 159 (2) ◽

pp. 274-282 ◽

Cited By ~ 1

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.

Download Full-text

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

Otolaryngology ◽

10.1177/0194599816686958 ◽

2017 ◽

Vol 156 (3) ◽

pp. 504-510 ◽

Cited By ~ 8

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.

Download Full-text

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

JAMA Otolaryngology–Head & Neck Surgery ◽

10.1001/jamaoto.2016.0127 ◽

2016 ◽

Vol 142 (4) ◽

pp. 328 ◽

Cited By ~ 1

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

Download Full-text

Faculty Opinions recommendation of American College of Surgeons National Surgical Quality Improvement Program assessment of risk factors for 30-day unplanned readmission in patients undergoing head and neck surgery requiring free tissue reconstruction.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736837135.793567720 ◽

2019 ◽

Author(s):

Giulio Cantu

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Head And Neck ◽

Neck Surgery ◽

Program Assessment ◽

Unplanned Readmission ◽

Improvement Program ◽

Surgical Quality ◽

American College Of Surgeons ◽

Tissue Reconstruction

Download Full-text

Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?

Otolaryngology ◽

10.1177/0194599819861524 ◽

2019 ◽

Vol 161 (4) ◽

pp. 629-634 ◽

Cited By ~ 2

Author(s):

Andrew J. Redmann ◽

Sonia N. Yuen ◽

Douglas VonAllmen ◽

Adam Rothstein ◽

Alice Tang ◽

...

Keyword(s):

Head And Neck ◽

Case Series ◽

Neck Surgery ◽

Mortality Rates ◽

Head And Neck Surgery ◽

Additional Case ◽

Complication Rates ◽

Total Cost ◽

Case Complexity ◽

Point Increase

Objectives (1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission. Study Design Retrospective case series. Setting Tertiary academic hospital. Subjects and Methods The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology–head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate. Results In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6. Conclusion For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.

Download Full-text

Transoral Endoscopic Head and Neck Surgery and Its Role Within the Multidisciplinary Treatment Paradigm of Oropharynx Cancer: Robotics, Lasers, and Clinical Trials

Journal of Clinical Oncology ◽

10.1200/jco.2015.62.3157 ◽

2015 ◽

Vol 33 (29) ◽

pp. 3285-3292 ◽

Cited By ~ 95

Author(s):

F. Christopher Holsinger ◽

Robert L. Ferris

Keyword(s):

Clinical Trials ◽

Head And Neck ◽

Multidisciplinary Treatment ◽

Three Dimensional ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Invasive Technique ◽

Swallowing Dysfunction ◽

Treatment Paradigm

Transoral endoscopic head and neck surgery is a new approach for the treatment of oropharyngeal tumors. Using either a robotic system and/or laser, surgeons gain access through the mouth via minimally invasive technique and thus have improved visualization of the tumors of the oropharynx, without disfiguring incisions. This transoral route of access minimizes long-term speech and swallowing dysfunction. Surgeons view this approach as a considerable technologic advance, analogous to the evolution in radiation therapy from conventional two- and three-dimensional conformal techniques to intensity-modulated techniques. Although the use of radiation with or without chemotherapy to treat oropharyngeal cancer (OPC) is supported by evidence from prospective clinical trials, there are no prospective data supporting the use of this new surgical approach for OPC. Here, we review the fundamentals of transoral endoscopic head and neck surgery, with robotics and laser technology, and discuss ongoing clinical trials for patients with OPC.

Download Full-text