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Thirty-Day Perioperative Outcomes in Pediatric Parotidectomy
John M Carter1, Jeffrey C Rastatter1, Bharat Bhushan1
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois2Department of Otolaryngology-Head and Neck Surgery, McGaw Medical Center of Northwestern University, Chicago, Illinois.
Insights
Pediatric parotidectomy has low short-term complications. Transient facial nerve weakness is common but usually resolves within two months, aiding parental counseling for parotid masses.
Area of Science:
- Pediatric Head and Neck Surgery
- Otolaryngology
- Surgical Oncology
Background:
- Limited data exists on short-term morbidity following parotidectomy in children.
- This information is crucial for parental counseling and treatment planning for pediatric parotid masses.
Purpose of the Study:
- To evaluate the 30-day perioperative outcomes of parotidectomy in pediatric patients.
- To assess complications, facial nerve function, reoperation, and readmission rates.
Main Methods:
- Prospective case series of 87 pediatric patients (90 parotidectomies) undergoing surgery between 2008 and 2015.
- Data collected on perioperative complications, facial nerve function, operative time, and length of stay.
- Focus on 30-day outcomes, including reoperation and readmission rates.
Main Results:
- Most parotidectomies (94%) were for benign conditions.
- Immediate postoperative facial weakness occurred in 36% of cases, more frequently after total parotidectomy and involving the lower branch.
- Transient facial nerve weakness resolved in 94% of affected patients within a mean of 61 days. Overall complications were 12%, with 3% requiring return to OR and 1% readmission.
Conclusions:
- Parotidectomy in children demonstrates a low rate of 30-day perioperative complications.
- Transient facial nerve weakness is a common, expected outcome, typically resolving within two months.
- The procedure is generally safe for managing pediatric parotid disease, with minimal major adverse events.
Importance:
Limited information exists about the short-term morbidity of parotidectomy in children. This information is important when counseling parents and planning treatment for children with parotid masses.
Objective:
To examine 30-day perioperative outcomes after parotidectomy in the pediatric population.
Design, Setting, And Participants:
A prospective case series of 87 pediatric patients who underwent parotidectomy from January 1, 2008, to June 30, 2015, performed by 2 pediatric head and neck specialists in a tertiary care pediatric hospital.
Main Outcomes And Measures:
Thirty-day perioperative complications, postoperative facial nerve function, reoperation rates, and readmission rates were the main outcome measures. Secondary outcome measures were operative time and length of stay.
Results:
Ninety parotidectomies (71 superficial and 19 total) were performed in 87 patients (48 male and 39 female). Mean age at operation was 8.3 years. Eighty-five of the cases (94%) were performed for benign disease. Mean operative time was 4.09 hours (range, 1.58-10.43 hours) and mean length of stay was 2.24 days (range, 0.97-4.33 days). Immediate postoperative facial weakness was observed in 32 cases (36%); 10 of these cases (31%) involved the upper branch and 29 (90%) involved the lower branch. Immediate postoperative paresis occurred more often after total parotidectomy vs superficial parotidectomy (11 of 19 [58%] vs 21 of 71 [30%]; P = .03) but was unrelated to the etiologic cause of the patients' parotid disease. Thirty of 32 cases (94%) of facial nerve weakness were transient, and the mean time to resolution was 61 days. Eleven complications (12%) other than facial nerve weakness occurred during the 30-day postoperative period. Three patients (3%) required a return to the operating room for hematoma or wound dehiscence. One patient (1%) required readmission in the 30-day postoperative period for contralateral parotitis.
Conclusions And Relevance:
We observed a low rate of 30-day perioperative complications as a result of superficial or total parotidectomy for pediatric parotid disease. Major adverse events included return to the operating room and 1 wound infection. Only 1 patient required readmission. Transient weakness of the facial nerve is relatively common, observed more often in the lower division, and can be expected to resolve in most patients by an average of 2 months.
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