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Complications Associated with Mortality after Head and Neck Surgery
Carolyn L Mulvey1, Jason A Brant1, Andrés M Bur1
11 Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Summary
Complications like pneumonia, renal insufficiency, bleeding, sepsis, stroke, and cardiac arrest significantly increase 30-day mortality risk in head and neck cancer surgery patients. These findings help assess complication severity in surgical outcomes.
Area of Science:
- Surgical Oncology
- Outcomes Research
- Health Services Research
Background:
- The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database is a valuable resource for analyzing surgical outcomes.
- Limited analysis exists on specific complications correlating with mortality in head and neck cancer surgery within the NSQIP database.
Purpose of the Study:
- To identify specific surgical complications that correlate with 30-day mortality in patients undergoing surgery for head and neck malignancies.
- To provide data for a more nuanced evaluation of complication severity in head and neck cancer surgery outcomes.
Main Methods:
- Retrospective review of prospectively collected data from the NSQIP database (2005-2014).
- Inclusion of cases identified by ICD-9 codes for head and neck malignancies.
- Multivariate logistic regression analysis to determine the association between individual complications and 30-day mortality, controlling for patient and surgical variables.
Main Results:
- Analysis of 15,410 cases revealed 3,499 complications in 2,235 cases.
- Postoperative pneumonia, progressive renal insufficiency, bleeding requiring transfusion, sepsis, septic shock, stroke, and cardiac arrest were independently associated with increased 30-day mortality.
- Odds ratios ranged from 2.39 for pneumonia to 135.59 for cardiac arrest, with significant p-values for all identified complications.
Conclusions:
- Specific complications significantly elevate the risk of 30-day mortality following head and neck cancer surgery.
- These identified associations can serve as a metric for complication severity when utilizing the NSQIP database for outcome evaluation.
- Further research and clinical attention to these high-risk complications are warranted.
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