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Pediatric Parotidectomy: Do Surgical Indications Affect Outcomes?
Christopher L Kalmar1, Vijay A Patel2, Jesse A Taylor1
1From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia.
Insights
Pediatric parotidectomy complication risks vary by indication. Malignant neoplasms increase nerve injury risk, while vascular malformations raise bleeding concerns. Lymphatic malformations show the lowest complication rates.
Area of Science:
- Pediatric surgery
- Otolaryngology
- Surgical quality improvement
Background:
- Parotid gland resections (parotidectomies) in children are performed for diverse pathologies.
- The specific indication for parotidectomy may influence the risk of adverse events.
- Understanding these risks is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To analyze and compare complication profiles of pediatric parotidectomy across various underlying pathologies.
- To identify specific indications associated with increased risks of adverse events following parotidectomy in children.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program Pediatric data set (2012-2017).
- Included 208 pediatric patients undergoing parotidectomy.
- Classified indications and analyzed complications, readmissions, and reoperations using statistical methods.
Main Results:
- Neoplasms were the most common indication (47.6%), followed by inflammatory conditions (24.0%).
- Malignant neoplasms significantly increased risks of nerve injury (OR, 3563) and medical complications (OR, 67.2).
- Vascular malformations were linked to higher bleeding risk (OR, 14.9), while lymphatic malformations had the lowest complication rates (0%).
Conclusions:
- Pediatric parotidectomy for malignant neoplasms carries a substantially higher risk of nerve injury.
- Vascular malformations are associated with an increased risk of bleeding requiring transfusion.
- Lymphatic malformations represent the lowest-risk indication for parotidectomy in children.
Background:
Parotid gland pathologies requiring resection present with varying effects on surrounding tissue architecture, and we hypothesize that this spectrum of indications confers different risks of adverse events. The purpose of this study is to elucidate the complication profiles of parotidectomy in children across a spectrum of pathologies requiring parotid resection.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program Pediatric data set was queried for parotidectomies performed from 2012 through 2017. Indications were subclassified based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Complications, readmissions, and reoperations were analyzed with appropriate statistics.
Results:
Parotidectomies in children (n = 208) were mostly performed for neoplasms (47.6%), followed by inflammatory conditions (24.0%). Total parotidectomies took significantly longer (P < 0.001) and remained in the hospital significantly longer than superficial parotidectomies (P < 0.001). There was no significant difference (P = 0.417) between benign neoplasms (29.3%) and malignant neoplasms (37.9%) requiring total parotidectomy. However, there was a significant difference (P = 0.014) across various malformations, with 83.3% of lymphatic malformations requiring total parotidectomy. Although lymphatic malformations required more aggressive resection, these procedures had the lowest rate of adverse events (0%). Despite the unappreciable predilection toward total parotidectomy based on nature of neoplasms, parotidectomy performed for malignant neoplasms had a significantly increased risk of nerve injury (P < 0.001; odds ratio [OR], 3563) and medical complications (P < 0.001; OR, 67.2), whereas those performed for benign neoplasms did not have an increased risk of these complications (all P's > 0.209). Parotidectomy performed for vascular malformations had significantly increased risk of bleeding requiring transfusion (P < 0.001; OR, 14.9) and surgical complications (P < 0.001; OR, 9.2). Bleeding requiring transfusion was significantly related to longer surgical procedures (P < 0.001; 409 vs 191 minutes).
Conclusions:
Parotidectomy in pediatric patients for malignant neoplasms is associated with a significantly higher risk of nerve injury compared with parotidectomy for benign neoplasms. Parotidectomy for vascular malformations has a significantly higher risk of bleeding requiring transfusion, whereas parotidectomy for lymphatic malformations is associated with the lowest risk of medical and surgical complications.
