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Monaghan NP, Duckett KA, Nguyen SA, Newman JG, Albergotti WG, Kejner AE. Vascular events in patients with head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1557-1572. [PMID: 38334324 DOI: 10.1002/hed.27675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To assess the incidence of vascular events in patients with head and neck cancer. REVIEW METHODS Primary studies identified through April 2023. Meta-analysis was performed. RESULTS There were 146 studies included in the systematic review. Rates of events were collected in the overall group, those with chemoprophylaxis, and those that underwent surgery, radiation, or chemotherapy. Of 1 184 160 patients, 4.3% had a vascular event. Radiation therapy had highest risk of overall events and stroke when compared to surgery and chemotherapy. Chemotherapy had a higher risk of stroke and overall events when compared to surgery. CONCLUSIONS Vascular events occur in 4%-5% of patients with head and neck cancer. Our data does not support the use of routine anticoagulation. Patients undergoing radiation therapy had the highest frequency of events.
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Affiliation(s)
- Neil P Monaghan
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey A Duckett
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason G Newman
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - W Greer Albergotti
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexandra E Kejner
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Chohan M, Liu W, Chowdhury T. Perioperative adverse cardiac events in maxillofacial surgery: A systematic review and meta-analysis. Indian J Anaesth 2024; 68:426-438. [PMID: 38764965 PMCID: PMC11100642 DOI: 10.4103/ija.ija_1206_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 05/21/2024] Open
Abstract
Background and Aims Maxillofacial surgeries, including procedures to the face, oral cavity, jaw, and head and neck, are common in adults. However, they impose a risk of adverse cardiac events (ACEs). While ACEs are well understood for other non-cardiac surgeries, there is a paucity of data about maxillofacial surgeries. This systematic review and meta-analysis report the incidence and presentation of perioperative ACEs during maxillofacial surgery. Methods We included primary studies that reported on perioperative ACEs in adults. To standardise reporting, ACEs were categorised as 1. heart rate and rhythm disturbances, 2. blood pressure disturbances, 3. ischaemic heart disease and 4. heart failure and other complications. The primary outcome was ACE presentation and incidence during the perioperative period. Secondary outcomes included the surgical outcome according to the Clavien-Dindo classification and trigeminocardiac reflex involvement. STATA version 17.0 and MetaProp were used to delineate proportion as effect size with a 95% confidence interval (CI). Results Twelve studies (34,227 patients) were included. The incidence of perioperative ACEs was 2.58% (95% CI 1.70, 3.45, I2 = 96.17%, P = 0.001). Heart rate and rhythm disturbances resulted in the greatest incidence at 3.84% among the four categories. Most commonly, these ACEs resulted in intensive care unit admission (i.e. Clavien-Dindo score of 4). Conclusion Despite an incidence of 2.58%, ACEs can disproportionately impact surgical outcomes. Future research should include large-scale prospective studies that may provide a better understanding of the contributory factors and long-term effects of ACEs in patients during maxillofacial surgery.
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Affiliation(s)
- Mehak Chohan
- Department of Health Science, Queen's University, Kingston, ON, Canada
| | - Winnie Liu
- Michael G. DeGroote School of Medicine, McMaster, Hamilton, ON, Canada
| | - Tumul Chowdhury
- Department of Anaesthesiology and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
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3
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Attia AS, Hussein M, Youssef MR, Omar M, Elnahla A, Farhoud A, Zora G, Reisner ASC, McClure B, Cox KS, Toraih E, Randolph GW, Kandil E. Deciphering excess healthcare burden in head and neck cancer patients with cardiovascular comorbidity. J Surg Oncol 2022; 125:968-975. [PMID: 35088904 DOI: 10.1002/jso.26802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to determine the perioperative surgical outcomes for head and neck cancer patients with cardiovascular diseases (CVDs). METHODS A cross-sectional analysis was performed using data from the Nationwide Readmissions Database between 2010 and 2014. Logistic regression analysis by enter and backward stepwise methods were used. RESULTS A total of 8346 patients met the inclusion criteria. Patients with concomitant CVD had a higher frequency of complications (57.6%) compared with those without (47.4%) (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.23-1.48, p < 0.001). Patients with CVD comorbidities were prone to experience in-patient mortality at both admission (OR = 2.4, 95% CI = 1.42-4.05) and readmission (OR = 2.55, 95% CI = 1.10-5.87). CVD patients have prolonged hospital admission (OR = 1.14, 95% CI = 1.02-1.27, p = 0.020) and higher cost (OR = 1.28, 95% CI = 1.15-1.43, p < 0.001). Patients with congestive heart failure were prone to 30 days readmission (OR = 1.67, 95% CI = 1.10-2.53, p = 0.019) and 90 days (OR = 1.65, 95% CI = 1.14-2.39, p = 0.010). CONCLUSION This is the first study identifying factors predicting higher risk of perioperative complications of surgical management of head and neck cancer. Those with CVD had higher risk of adverse events.
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Affiliation(s)
- Abdallah S Attia
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohammad Hussein
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohanad R Youssef
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mahmoud Omar
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ahmed Elnahla
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ashraf Farhoud
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ghassan Zora
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Adin S C Reisner
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brian McClure
- Department of Anesthesiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Katherine S Cox
- Department of Anesthesiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Eman Toraih
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Genetics Unit, Histology and Cell Biology Department, Suez Canal University, Ismailia, Egypt
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Emad Kandil
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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4
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Pai K, Baaklini C, Cabrera CI, Tamaki A, Fowler N, Maronian N. The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review. Laryngoscope 2021; 132:1388-1402. [PMID: 34661923 DOI: 10.1002/lary.29905] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the utility of comorbidity index (CI) scores in predicting outcomes in head and neck surgery (HNS). The CIs evaluated were the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Kaplan-Feinstein Index (KFI), American Society of Anesthesiologists Physical Status (ASA-PS), Adult Comorbidity Evaluation-27 (ACE-27), National Cancer Institute Comorbidity Index (NCI-CI), and the Washington University Head and Neck Comorbidity Index (WUHNCI). METHODS We report a systematic review according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases (PubMed, Cochrane, and Embase) and manual search of bibliographies identified manuscripts addressing how CI scores related to HNS outcomes. RESULTS A total of 116 studies associated CI scores with HNS outcomes. CIs were represented in the literature as follows: ASA-PS (70/116), CCI (39/116), ACE-27 (24/116), KFI (7/116), NCI-CI (3/116), ECI (2/116), and WUHNCI (1/116). The most frequently cited justification for calculating each CI (if provided) was: CCI for its validation in other studies, ACE-27 for its utility in cancer patients, and ECI for its comprehensive design. In general, the CCI and ACE-27 were predictive of mortality in HNS. The ECI was most consistent in predicting >1-year mortality. The ACE-27 and KFI were most consistent in predicting medical complications. CONCLUSION Despite inconsistencies in the literature, CIs provide insights into the impact of comorbidities on outcomes in HNS. These scores should be employed as an adjunct in the preoperative assessment of HNS patients. Comparative studies are needed to identify indices that are most reliable in predicting HNS outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Kavya Pai
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.A
| | - Carla Baaklini
- Northeast Ohio Medical University, Rootstown, Ohio, U.S.A
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Maronian
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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5
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Cardiopulmonary exercise testing and cardiopulmonary morbidity in patients undergoing major head and neck surgery. Br J Oral Maxillofac Surg 2020; 59:297-302. [PMID: 33589309 DOI: 10.1016/j.bjoms.2020.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022]
Abstract
Cardiopulmonary exercise testing (CPET) is used as a risk stratification tool for patients undergoing major surgery. In this study, we investigated the role of CPET in predicting day five cardiopulmonary morbidity in patients undergoing head and neck surgery. This observational cohort study included 230 adults. We recorded preoperative CPET variables and day five postoperative cardiopulmonary morbidity. Full data from 187 patients were analysed; 43 patients either had incomplete data sets or declined surgery/CPET. One hundred and nineteen patients (63.6%) developed cardiopulmonary morbidity at day five. Increased preoperative heart rate and duration of surgery were independently associated with day five cardiopulmonary morbidity. Those with such morbidity also had lower peak V̇O2 11.4 (IQR 8.4-18.0) vs 16.0 (IQR 14.0-19.7) ml.kg-1.min-1, P<0.0001 and V̇O2 at AT 10.6 (IQR 9.1-13.1) vs 11.5 (IQR 10.5-13.0) ml.kg-1.min-1, p=0.03. Logistic regression model containing peak V̇O2 and duration of surgery demonstrated that increased peak V̇O2 was associated with a reduction in the likelihood of cardiopulmonary complications OR 0.92 (95%CI 0.87 to 0.96), p=0.001. The area under the receiver operating characteristic curve for this model was 0.75(95%CI 0.68 to 0.82), p<0.0001, 64% sensitivity, 81% specificity. CPET can help to predict day five cardiopulmonary morbidity in the patients undergoing head and neck surgery. A model containing peak V̇O2 allowed identification of those with such complications.
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6
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Silverman DA, Lin C, Tamaki A, Puram SV, Carrau RL, Seim NB, Eskander A, Rocco JW, Old MO, Kang SY. Respiratory and pulmonary complications in head and neck cancer patients: Evidence-based review for the COVID-19 era. Head Neck 2020; 42:1218-1226. [PMID: 32343013 PMCID: PMC7267530 DOI: 10.1002/hed.26217] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the 2019 coronavirus disease (COVID-19) pandemic. METHODS A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients. RESULTS Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment toxicities from radiation or chemoradiation therapy significantly increase these risks. CONCLUSION Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population. Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients.
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Affiliation(s)
- Dustin A Silverman
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Chen Lin
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Akina Tamaki
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, Ear, Nose & Throat Center, St. Louis, Missouri, USA
| | - Ricardo L Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Nolan B Seim
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, USA
| | - James W Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Matthew O Old
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
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7
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Shepherd SJ, Creber N, Mansour K, Wiesenfeld D, Iseli TA, Amott D. Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery. ANZ J Surg 2019; 90:851-855. [DOI: 10.1111/ans.15611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Sally J. Shepherd
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Nathan Creber
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Kristy Mansour
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - David Wiesenfeld
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Tim A. Iseli
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Deborah Amott
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
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8
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McHugh T, Zhang H, Xie M, Gupta MK. Elevated Troponin: A Marker for Noncardiac Complications After Resection of Head and Neck Cancers. Laryngoscope 2019; 130:2148-2152. [PMID: 31566743 DOI: 10.1002/lary.28291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine if troponin positivity (TP) in patients who undergo head and neck cancer mucosal resections (HNS) predicts noncardiac complications (NCC). BACKGROUND Major HNSs are arduous operations that place stress on the patient's hemodynamic system. TP after noncardiac surgery previously has been shown in up to 25% of patients, which may signal cardiac complications (CC) or NCC. Although CC after HNS has been observed, no study has investigated the relationship of TP to NCC. METHODS All patients who underwent HNS at a tertiary-care cancer center from July 2014 to July 2016 were included and underwent postoperative troponin measurements as part of an institutional cardiac protocol. Comparative and multivariate regression analysis were used to compare TP and troponin-negative (TN) patients for NCC. RESULTS One hundred seventy-two patients underwent HNS. Of those, 15% developed TP during the postoperative period. There was no significant difference between TP and TN for gender, tumor-node-metastasis staging, Charlson comorbidity index, and smoking status. Risk of NCC in TP was 73.1% versus 28.1% in TN (P < 0.001). A significant difference (P < 0.05) in wound complications, length of hospital stay (LOHS), and incidence of pneumonia was found between both groups. Nonparametric testing confirmed significant difference in pneumonia (Z = -3.469, P = 0.001) and LOHS (-3.110, P = 0.002). Multivariate regression analysis confirmed a significant difference in LOHS independent of CC (R2 = 0.122, P < 0.0001). CONCLUSION TP is not an uncommon occurrence after HNS and is associated with statistically significant increases in wound complications, LOHS, and pneumonia. However, the overall significance of these findings remains unclear, and further research is warranted to determine if outcomes may be improved by closely monitoring these patients for TP. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2148-2152, 2020.
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Affiliation(s)
- Tobial McHugh
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Han Zhang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Xie
- McMaster Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Michael K Gupta
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
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9
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Scaglioni MT, Giovanoli P, Scaglioni MF, Yang JCS. Microsurgical head and neck reconstruction in patients with coronary artery disease: A perioperative assessment algorithm. Microsurgery 2019; 39:290-296. [PMID: 30648284 DOI: 10.1002/micr.30429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/24/2018] [Accepted: 12/27/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND With the rising number of patients in advanced age receiving microsurgical procedures, coronary artery disease (CAD) and its challenging management is of increasing importance. Evidence based data concerning morbidity and mortality are rare. We present our experiences with this highly selected patient population and propose a preoperative assessment algorithm. PATIENTS AND METHODS Between January 2006 and May 2016, a total of 57 patients with CAD received 58 free flaps. Median age of our patients was 64 years (interquartile range 57.5-70.0). Squamous cell carcinoma was the reason for reconstruction in all cases. Defect of the buccal, gum, tongue, lip, trigone, palatal, and hypopharyngeal regions were reconstructed. Patient characteristics and comorbidities were recorded. We especially focused on the preoperative cardiac assessment and treatment of patients who were scheduled for microsurgical free tissue transfer such as medical history, cardiac risk assessment, and further cardiac testing such as Doppler-echocardiography and myocardial perfusion assessment. Intraoperative course as well as postoperative morbidity and mortality was described. RESULTS About 54.4% of the selected cohort received cardiac catheterization due to a clinical preoperative cardiac assessment performed individually by the cardiologist on duty. In total, 52 fasciocutaneous anterolateral thigh flaps, four osteocutaneous fibula flaps, and two radial forearm flaps were performed. The flap survival rate was 96.6%. The overall surgical complication rate was 28.1% (16 patients), mostly due to wound infections (seven cases) and partial flap necrosis (four cases). Three patients died, resulting in a mortality rate of 5.2%. CONCLUSION CAD patients receiving head and neck microsurgical reconstructions are still at high risk for adverse consequences due to surgery. The microsurgical community is requested to share the experience of those cases in order to develop reliable and evidence based statements of the perioperative risks and prognosis for these patients. We additionally introduce a standardized perioperative cardiac assessment and treatment algorithm for head and neck surgery patients with CAD.
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Affiliation(s)
- Marie-Therese Scaglioni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Mario F Scaglioni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Johnson Chia-Shen Yang
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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10
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Incidence and predictors of 30-day cardiovascular complications in patients undergoing head and neck cancer surgery. Eur Arch Otorhinolaryngol 2016; 273:4601-4606. [DOI: 10.1007/s00405-016-4164-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
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11
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Haapio E, Kinnunen I, Airaksinen JKE, Irjala H, Kiviniemi T. Excessive intravenous fluid therapy in head and neck cancer surgery. Head Neck 2016; 39:37-41. [PMID: 27299857 DOI: 10.1002/hed.24525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The purpose of this retrospective study was to present our assessment of modifiable perioperative factors for major cardiac and cerebrovascular events (MACCE). METHODS This study included an unselected cohort of patients with head and neck cancer (n = 456) treated in Turku University Hospital between 1999 and 2008. RESULTS Perioperative and postoperative univariate predictors of MACCE at 30-day follow-up were: total amount of fluids (during 24 hours) over 4000 mL, any red blood cell (RBC) infusion, treatment in the intensive care unit (ICU), tracheostomy, and microvascular reconstruction surgery. Median time from operation to MACCE was 3 days. Patients receiving >4000 mL of fluids had MACCE more often compared with those receiving <4000 mL (10.8% vs 2.4%; p < .001, respectively). Moreover, every RBC unit transfused or every liter of fluid administered over 4000 mL/24h increased the risk of MACCE 18% per unit/liter, respectively. CONCLUSION Patients with head and neck cancer receiving excessive intravenous fluid administration perioperatively and postoperatively are at high risk for cardiac complications, especially heart failure. © 2016 Wiley Periodicals, Inc. Head Neck 39: 37-41, 2017.
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Affiliation(s)
- Eeva Haapio
- Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilpo Kinnunen
- Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Heikki Irjala
- Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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12
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Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care. Can Respir J 2016; 2016:6019416. [PMID: 27445554 PMCID: PMC4906186 DOI: 10.1155/2016/6019416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/03/2016] [Indexed: 11/17/2022] Open
Abstract
Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS). Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS), a Healthcare Cost and Utilization Project (HCUP) subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC) of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P < 0.001); the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P = 0.01). Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.
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13
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Loeffelbein DJ, Julinek A, Wolff KD, Kochs E, Haller B, Haseneder R. Perioperative risk factors for postoperative pulmonary complications after major oral and maxillofacial surgery with microvascular reconstruction: A retrospective analysis of 648 cases. J Craniomaxillofac Surg 2016; 44:952-7. [PMID: 27259678 DOI: 10.1016/j.jcms.2016.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/01/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs) are common and result in prolonged hospital stays, higher costs and increased mortality. However, data on the incidence and predictors of PPCs after major oral and maxillofacial surgery with microvascular reconstruction are rare. This retrospective analysis identifies perioperative risk factors for postoperative pulmonary complications (PPCs) after major oral and maxillofacial surgery with microvascular reconstruction. METHODS Perioperative data and patient records of 648 subjects were analyzed in the period of June 2007 to May 2013. PPCs were defined as pneumonia, atelectasis, pleural effusions, pulmonary embolism, pulmonary oedema, pneumothorax or respiratory failure. RESULTS 18.8% of all patients developed PPCs. Patient-related risk factors for PPCs were male sex, advanced age, smoking, alcohol abuse, a body mass index >30, American Society of Anaesthesiologists grade higher than 2, pre-existent pulmonary diseases and preoperative antihypertensive medication. Among the investigated procedure-related variables, the length of the operation, the amount of fluid administration and blood transfusion and an impaired oxygenation index during surgery were shown to be associated with the development of PPCs. Using a multivariable logistic regression model, we identified a body mass index >30, American Society of Anaesthesiologists grade higher than 2 and alcohol abuse as independent risk factors for PPCs. CONCLUSIONS Several perioperative factors can be identified that are associated with the development of PPCs. Patients having one or more of these conditions should be subjected to intensified postoperative pulmonary care.
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Affiliation(s)
- Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany.
| | - Annette Julinek
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Germany
| | - Eberhard Kochs
- Department of Anaesthesiology, Technische Universität München, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Rainer Haseneder
- Department of Anaesthesiology, Technische Universität München, Germany
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Nouraei S, Mace A, Middleton S, Hudovsky A, Vaz F, Moss C, Ghufoor K, Mendes R, O'Flynn P, Jallali N, Clarke P, Darzi A, Aylin P. A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics-based Outcomes Surveillance Framework. Clin Otolaryngol 2016; 42:11-28. [DOI: 10.1111/coa.12649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S.A.R. Nouraei
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
- National Institute of Health and Care Excellence (NICE) 2013 Scholar; London UK
- The Ear Institute; University College London; London UK
| | - A.D. Mace
- Department of Otolaryngology - Head & Neck Surgery; Imperial College Healthcare NHS Trust; London UK
| | | | - A. Hudovsky
- Department of Clinical Coding; Imperial College Healthcare NHS Trust; London UK
| | - F. Vaz
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
| | - C. Moss
- Department of Oral & Maxillofacial Surgery; University College Hospital NHS Foundation Trust; London UK
| | - K. Ghufoor
- Department of Otolaryngology - Head & Neck Surgery; Barts Health, Royal London Hospital; London UK
| | - R. Mendes
- Department of Clinical Oncology; University College Hospital NHS Foundation Trust; London UK
| | - P. O'Flynn
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
| | - N. Jallali
- Department of Plastic & Reconstructive Surgery; Imperial College Healthcare NHS Trust; London UK
| | - P.M. Clarke
- Department of Otolaryngology - Head & Neck Surgery; Imperial College Healthcare NHS Trust; London UK
| | - A. Darzi
- Academic Surgical Unit; Department of Surgery & Cancer; St Mary's Hospital; London UK
| | - P. Aylin
- Dr Foster Unit at Imperial College; Department of Primary Care and Public Health; Imperial College London; London UK
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15
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Lee HJ, Kim JW, Choi SY, Kim CS, Kwon TG, Paeng JY. The evaluation of a scoring system in airway management after oral cancer surgery. Maxillofac Plast Reconstr Surg 2015; 37:19. [PMID: 26247006 PMCID: PMC4518133 DOI: 10.1186/s40902-015-0021-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this retrospective study was to investigate the usefulness of tracheostomy scoring system in the decision of postoperative airway management in oral cancer patients. MATERIALS AND METHODS A total of 104 patients were reviewed in this retrospective study, who underwent radical resection with or without neck dissection and free flap reconstruction due to oral cancer. The patients were classified into three groups according to the timing of the extubation; extubated groups (n = 51), overnight intubation group (n = 45), and tracheostomy group (n = 8). Cameron's score was used to evaluate the relation between the state of the patient's airway and the type of the operation. RESULTS Tracheostomy was performed in eight patients (8/104, 7.7 %). A total of 22 patients (21.2 %) had more than 5 points of which 17 patients (77.3 %) did not have a tracheostomy and any postoperative emergency airway problems. The tracheostomy scores were significantly different among the three groups. Hospital stay showed a significant correlation with the tracheostomy score. CONCLUSIONS The scoring system did not quite agree with the airway management of the authors' clinic; however, it can be one of the clinical factors predicting the degree of the postoperative airway obstruction and surgical aggressiveness for recovery. The further studies are needed for clinically more reliable scoring systems.
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Affiliation(s)
- Ho-Jin Lee
- Department of Oral and Maxillofacial Surgery, Sahmyook Adventist Dental Hospital, Seoul, Republic of Korea
| | - Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2175 Dalgubeoldae-ro, Daegu, 700-705 South Korea
| | - So-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2175 Dalgubeoldae-ro, Daegu, 700-705 South Korea
| | - Chin-Soo Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2175 Dalgubeoldae-ro, Daegu, 700-705 South Korea
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2175 Dalgubeoldae-ro, Daegu, 700-705 South Korea
| | - Jun-Youg Paeng
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2175 Dalgubeoldae-ro, Daegu, 700-705 South Korea
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16
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Patel AJ, Suki D, Hatiboglu MA, Rao VY, Fox BD, Sawaya R. Impact of surgical methodology on the complication rate and functional outcome of patients with a single brain metastasis. J Neurosurg 2015; 122:1132-43. [PMID: 25794344 DOI: 10.3171/2014.9.jns13939] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Brain metastases are the most common intracranial neoplasms and are on the increase. As radiation side effects are increasingly better understood, more patients are being treated with surgery alone with varying outcomes. The authors previously reported that en bloc resection of a single brain metastasis was associated with decreased incidences of leptomeningeal disease and local recurrence compared with piecemeal resection. However, en bloc resection is often feared to cause an increased incidence of postoperative complications. This study aimed to answer this question. METHODS The authors reviewed data from patients with a previously untreated single brain metastasis, who were treated with resection at The University of Texas M.D. Anderson Cancer Center (1993-2012). Data related to the patient, tumor, and methods of resection were obtained. Discharge Karnofsky Performance Scale (KPS) scores and 30-day postoperative complications were noted. Complications were considered major when they persisted for longer than 30 days, resulted in hospitalization or prolongation of hospital stay, required aggressive treatment, and/or were life threatening. RESULTS During the study period, 1033 eligible patients were identified. The median age was 58 years, 83% had a KPS score greater than 70, and 81% were symptomatic at surgery. Sixty-two percent of the patients underwent en bloc resection of their tumor, and 38% underwent piecemeal resection. There were significant differences between the 2 groups in terms of preoperative tumor volume, tumor functional grade, and symptoms at presentation, among others. The overall complication rates were 13% for patients undergoing en bloc resection and 19% for patients undergoing piecemeal resection (p = 0.007). The incidences of major complications and neurological complications were also significantly different. There was a trend in the same direction for major neurological complications, although it was not significant. Among patients undergoing piecemeal resection of tumors in eloquent cortex, 24% had complications (13% had major, 18% had neurological, 9% had major neurological, and 13% had select neurological complications; 4% died within 1 month of surgery). Among those undergoing en bloc resection of such tumors, 11% had complications (6% had major, 8% had neurological, 4% had major neurological, and 4% had select neurological; 2% died within 1 month of surgery). The differences in overall, major, neurological, and select neurological complications were statistically significant, but 1-month mortality and major neurological complications were not. In addition, within subcategories of tumor volume, the incidence of various complications was generally higher for patients undergoing piecemeal resection than for those undergoing en bloc resection. CONCLUSIONS The authors' results indicate that postoperative complication rates are not increased by en bloc resection, including for lesions in eloquent brain regions or for large tumors. This gives credence to the idea that en bloc resection of brain metastases, when feasible, is at least as safe as piecemeal resection.
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Affiliation(s)
- Akash J Patel
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center; and
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17
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Nouraei S, Middleton S, Hudovsky A, Darzi A, Stewart S, Kaddour H, Alam P, Jallali N, Birchall M, Ghufoor K, Aylin P, Clarke P, Bottle A. A national analysis of the outcome of major head and neck cancer surgery: implications for surgeon-level data publication. Clin Otolaryngol 2013; 38:502-11. [DOI: 10.1111/coa.12185] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- S.A.R. Nouraei
- Department of Otolaryngology - Head & Neck Surgery; Queen's Hospital; Romford UK
- National Institute of Health and Care Excellence (2013 Scholar); London UK
| | | | - A. Hudovsky
- Department of Clinical Coding; Charing Cross Hospital; London UK
| | - A. Darzi
- Academic Department of Surgery; Imperial College London; London UK
| | - S. Stewart
- Department of Clinical Oncology; Charing Cross Hospital; London UK
| | - H. Kaddour
- Department of Otolaryngology - Head & Neck Surgery; Queen's Hospital; Romford UK
| | - P. Alam
- Department of Oral & Maxillofacial Surgery; St Richard's Hospital; Chichester UK
| | - N. Jallali
- Department of Plastic & Reconstructive Surgery; Charing Cross Hospital; London UK
| | - M.A. Birchall
- The Royal National Throat Nose and Ear Hospital; London UK
| | - K. Ghufoor
- Department of Otolaryngology - Head & Neck Surgery; Royal London Hospital; London UK
| | - P. Aylin
- Dr Foster Unit at Imperial College; Department of Primary Care and Public Health; School of Public Health; Imperial College London; London UK
| | - P.M. Clarke
- Department of Otolaryngology - Head & Neck Surgery; Charing Cross Hospital; London UK
| | - A. Bottle
- Dr Foster Unit at Imperial College; Department of Primary Care and Public Health; School of Public Health; Imperial College London; London UK
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18
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19
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Peters TTA, van Dijk BAC, Roodenburg JLN, van der Laan BFAM, Halmos GB. Relation between age, comorbidity, and complications in patients undergoing major surgery for head and neck cancer. Ann Surg Oncol 2013; 21:963-70. [PMID: 24248531 DOI: 10.1245/s10434-013-3375-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple factors have been identified as predictors of complication after head and neck surgery. However, little is known about the exact role of different comorbid conditions in the development of postoperative complications. This question is especially interesting in the elderly population. The aim of this study was to investigate the association between comorbidity and types of postoperative complications with special attention to age differences. METHODS A retrospective analysis was performed of 1,201 major surgical interventions for head and neck malignancies in a tertiary referral center between 1995 and 2010. The Adult Comorbidity Evaluation 27 (ACE-27) index was used to analyze severity (mild, moderate, and severe comorbidity) and type (12 different organ systems) of comorbidity. The Clavien-Dindo index was used to evaluate grade and type of complications after treatment. RESULTS In univariate analysis gender, comorbidity, stage, mandibulectomy, total laryngectomy, neck dissection, and length of surgery significantly predicted grade of complication. In a multivariate analysis, complication was predicted by age, stage, length of surgery, and various comorbidities. After specification of the complications, age was only a predictor of medical complications; tumor stage was a significant factor in surgical complications. Length of surgery was the only significant variable in all types of complications. CONCLUSIONS Specific comorbidities are associated with specific complications; however, age itself seems not to be a contraindication for major head and neck surgery. With careful preoperative assessment and risk analysis, physicians can better individualize treatment recommendations.
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Affiliation(s)
- Thomas T A Peters
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
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20
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Huitink JM, Teoh WHL. Current cancer therapies - a guide for perioperative physicians. Best Pract Res Clin Anaesthesiol 2013; 27:481-92. [PMID: 24267553 DOI: 10.1016/j.bpa.2013.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 12/20/2022]
Abstract
Cancer is expected to be the leading cause of death around the world. New cancer therapies have improved survival but they can also lead to complications and toxicity. In this article, the effects of modern anti-cancer therapies are reviewed. The perioperative effects of chemotherapy, radiotherapy and experimental therapies in relation to anaesthesia are discussed. Common and rare complications are summarised as is advice for optimal treatment of the cancer patient in the perioperative period.
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Affiliation(s)
- Johannes M Huitink
- Department of Anaesthesiology, VU University Medical Center/VUmc Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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21
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Montero-Miranda PH, Ganly I. Survivorship--competing mortalities, morbidities, and second malignancies. Otolaryngol Clin North Am 2013; 46:681-710. [PMID: 23910478 DOI: 10.1016/j.otc.2013.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mortality of head and neck cancer has declined in the United States over the past 20 years. This improvement has been linked to use of multimodality treatment of advanced disease. Despite this improvement, disease-specific survival remains low. Patients who survive head and neck cancer are exposed to morbidity and mortality secondary to the same factors as the general population. Factors related to cancer and cancer treatment predispose them to increased risk of mortality. Improvements in head and neck cancer treatment have led to a scenario where an increasing proportion of patients die from causes other than the primary cancer, called competing mortalities.
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Affiliation(s)
- Pablo H Montero-Miranda
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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22
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Brickman DS, Reh DD, Schneider DS, Bush B, Rosenthal EL, Wax MK. Airway management after maxillectomy with free flap reconstruction. Head Neck 2012; 35:1061-5. [DOI: 10.1002/hed.23082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2012] [Indexed: 11/09/2022] Open
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23
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Vaz JA, Côté DWJ, Harris JR, Seikaly H. Outcomes of free flap reconstruction in the elderly. Head Neck 2012; 35:884-8. [DOI: 10.1002/hed.23057] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 11/06/2022] Open
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24
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Panoramic Radiographs of Head and Neck Cancer Patients Are Often Evidence of Carotid Artery Atherosclerotic Lesions: A Sign of High-Risk Comorbid Illness. J Oral Maxillofac Surg 2012; 70:1096-101. [DOI: 10.1016/j.joms.2011.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/18/2011] [Accepted: 05/19/2011] [Indexed: 01/22/2023]
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25
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Lin HW, Bhattacharyya N. Contemporary Assessment of Medical Morbidity and Mortality in Head and Neck Surgery. Otolaryngol Head Neck Surg 2011; 146:385-9. [DOI: 10.1177/0194599811428557] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To update the incidence of medical morbidity and mortality in head and neck surgery and factors that influence length of stay (LOS). Study Design. Cross-sectional analysis of a national database. Setting. Academic medical center. Methods. A specific database for head and neck surgical procedures was extracted from the National Hospital Data Survey for 2005 through 2007. Records of inpatient admissions for patients undergoing head and neck surgery as the primary procedure were examined to establish the frequency of medical complications, mortality, and LOS. The association of these medical complications with mortality and LOS was determined. Results. A total of 330,629 head and neck procedures were analyzed. The overall medical morbidity and mortality rates were 5.0% ± 0.7% and 0.4% ± 0.2%, respectively. The most common medical complication was hospital-acquired pneumonia (3.3% ± 0.6%), whereas acute renal failure, stroke, acute myocardial infarction, pulmonary embolism, and deep venous thrombosis were substantially less frequent (combined incidence, 2.1%). The mean LOS for patients without a major complication was 3.3 ± 0.2 days vs 14.0 ± 1.9 days for those with a major complication ( P < .001). Conclusions. Medical morbidity and mortality in patients undergoing head and neck surgical procedures continue to be exceedingly low. Although medical complications are associated with a longer LOS, the influence of medical complications on mortality has declined. Enhancements in perioperative medical management of head and neck surgical patients are likely responsible for these improved results.
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Affiliation(s)
- Harrison W. Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Bhattacharyya
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Sierszeń W. Medical complications of surgical procedures in head and neck cancer patients. Otolaryngol Pol 2011; 65:258-61. [PMID: 22000141 DOI: 10.1016/s0030-6657(11)70686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 04/15/2011] [Indexed: 11/17/2022]
Abstract
The surgical treatment of head and neck cancer can be limited by the risk of postoperative complications, both local and medical. When it occurs, it usually leads to prolonged length of stay after the surgery and sometimes can be life-threatening. Early identification of risk factors based on clinical data is essential and is helpful in medical treatment.
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27
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Lusardi JJ, Buchanan PM, Christopher KM, Varvares MA. Salvage Surgery following Radiation Failure for Laryngeal Cancer in Elderly Patients. Otolaryngol Head Neck Surg 2011; 145:759-66. [DOI: 10.1177/0194599811414396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To find the survival rate of patients ≥80 years old who undergo salvage surgery for squamous cell carcinoma of the larynx. Study Design. National data registry analysis. Setting. Seventeen population-based registries comprising the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Subjects and Methods. Overall, cancer-specific, and relative survival rates were calculated from 1418 patients, stratified into 3 age cohorts, who underwent surgery following radiation therapy for treatment of laryngeal cancer. Results. The 1-year overall survival of patients ≥80 years old (n = 57) was 76.1%. The cancer-specific survival at 1 year was 86.4%. These survival rates were significantly less than those of patients <65 years old (n = 869), who had a 1-year overall survival of 88.1% ( P = .006) and cancer-specific survival of 90.5% ( P = .029). Patients aged between 65 and 79 years old (n = 492) displayed 1-year overall survival of 80.7% ( P = .426) and cancer-specific survival of 85.1% ( P = .711), which were not significantly different from the ≥80 year cohort. When comparing relative survival at 5 years, the ≥80-year-old cohort’s survival trended the highest (≥80 years, 62.8%; 65-79 years, 51.3%; 20-64 years, 56.2%). Conclusion. While patients ≥80 years old have a less favorable prognosis than patients <65 years old, the survival rates of patients ≥80 years old are not significantly different from the 65- to 79-year-old cohort. After controlling for non-cancer-related death, patients ≥80 years old appear to have similar 5-year survival outcomes compared with other patients.
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Affiliation(s)
| | - Paula M. Buchanan
- Saint Louis University Center for Outcomes Research, Academic Unit of Saint Louis University School of Medicine, St Louis, Missouri, USA
| | | | - Mark A. Varvares
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri, USA
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28
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Espinosa Domínguez E, Reverón Gómez MA, Pérez Méndez L, Martínez Gimeno C, Moure García E, Yanes Luque E. [Risk factors for postoperative complications in major head and neck surgery]. ACTA ACUST UNITED AC 2011; 58:218-22. [PMID: 21608277 DOI: 10.1016/s0034-9356(11)70043-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Tumor extension is the factor that usually determines the choice of radiotherapy or surgery for head and neck cancers. The choice of surgery carries with it certain specific risks that must be assessed jointly by the maxillofacial surgeon and the anesthetist so that they can agree on the best course of action to choose. We aimed to identify risk factors for complications after major head and neck surgery. PATIENTS AND METHODS Retrospective descriptive analysis of data for patients who underwent oncologic head and neck surgery with graft reconstruction. The main candidate predictors gathered from records were age, sex, ASA physical status classification, time under anesthesia, and intra- and postoperative events. The main dependent variables were records of early and delayed complications, time until extubation, and related mortality. RESULTS We identified 61 interventions in 56 patients (mean duration of surgery, 9 hours). Early complications developed in 57.4% while they were in the critical care area. Age > or =60 years was associated with longer hospital stays. Short-term mortality was higher in current smokers (P= .01). Survival was significantly higher in patients classified ASA 1 or 2 in comparison with those classified as ASA 3 or 4, in whom long-term mortality was higher (P < .05). CONCLUSIONS The incidence of postoperative complications was associated with comorbidity and risk behaviors found in this type of patient. We feel that a multidisciplinary medical team should assess the surgical and postoperative care of these patients.
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Affiliation(s)
- E Espinosa Domínguez
- 'Senrvicio de Anestesiologfa y Reanimación, Hospital Universitario Nuestra Sehora de Candelaria, Santa Cruz de Tenerife.
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Landis SH, El-Hariry IA, van Herk-Sukel MPP, van den Haak P, Janssen-Heijnen MLG, Penning-van Beest FJA, Herings RMC. Prevalence and incidence of acute and chronic comorbidity in patients with squamous cell carcinoma of the head and neck. Head Neck 2011; 34:238-44. [DOI: 10.1002/hed.21720] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 10/25/2010] [Accepted: 12/13/2010] [Indexed: 11/08/2022] Open
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Oral and oropharyngeal cancer in the West of Scotland—long-term outcome data of a prospective audit 1999–2001. Br J Oral Maxillofac Surg 2011; 49:92-8. [DOI: 10.1016/j.bjoms.2009.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 12/09/2009] [Indexed: 11/20/2022]
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Dillon JK, Liu SY, Patel CM, Schmidt BL. Identifying risk factors for postoperative cardiovascular and respiratory complications after major oral cancer surgery. Head Neck 2011; 33:112-6. [DOI: 10.1002/hed.21411] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Kanatas A, Gorton H, Smith AB, Mannion C, Ong TK, Mitchell D. ASA grade and disease-free mortality in head and neck cancer patients: A prospective study. Br J Oral Maxillofac Surg 2010; 48:591-3. [DOI: 10.1016/j.bjoms.2009.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 11/07/2009] [Indexed: 11/16/2022]
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Avery C, Crank S, Neal C, Hayter J, Elton C. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient. Oral Oncol 2010; 46:829-33. [DOI: 10.1016/j.oraloncology.2010.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/09/2010] [Accepted: 08/09/2010] [Indexed: 11/15/2022]
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Kesting MR, Robitzky L, Al-Benna S, Steinstraesser L, Baurecht H, Wolff KD, Hölzle F, Nieberler M, Mücke T, Loeffelbein DJ. Bronchoscopy screening in primary oral squamous cell carcinoma: a 10-year experience. Br J Oral Maxillofac Surg 2009; 47:279-83. [PMID: 19243866 DOI: 10.1016/j.bjoms.2009.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2009] [Indexed: 11/19/2022]
Abstract
Squamous cell carcinoma (SCC) in the head and neck is associated with synchronous or metachronous carcinomas of the lung. Preoperative pulmonary screening is advocated and may be done by bronchoscopy, thoracic radiograph, computed tomography (CT), or positron emission tomography (PET) with CT (PET/CT fusion). We evaluated the role of bronchoscopy in patients with primary oral SCC to ascertain the incidence of synchronous malignancies of the lung. We retrospectively reviewed a decade's experience of screening by bronchoscopy in 570 pathologically confirmed and previously untreated patients with oral SCC (188 female, 382 male). Univariate and multivariate analyses were done after evaluating the incidence of synchronous lesions and the clinical and histological features of the index tumour. Investigation by bronchoscopy showed disease in 166 patients, and malignancy of the lung in 9 (2%). The Union International contre le Cancer (UICC) stages I and II oral SCC were significantly associated with a synchronous malignancy of the lung (p=0.038). We recommend the use of bronchoscopy even in early tumour stages. Some patients had their treatment altered because of its use, including upstaging, diagnosis of distant and unresectable disease, and investigation of second primary malignancies.
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Affiliation(s)
- Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, Technische Universität München, München, Germany
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Dillon JK. Identifying Perioperative Risk Factors for Respiratory and Cardiovascular Complications After Major Oral Cancer Surgery. J Oral Maxillofac Surg 2008. [DOI: 10.1016/j.joms.2008.05.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hoebers FJP, Heemsbergen W, Balm AJM, van Zanten M, Schornagel JH, Rasch CRN. Concurrent chemoradiation with daily low dose cisplatin for advanced stage head and neck carcinoma. Radiother Oncol 2007; 85:42-7. [PMID: 17445927 DOI: 10.1016/j.radonc.2007.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 03/20/2007] [Accepted: 03/22/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate treatment results of concurrent chemoradiation with daily low dose cisplatin. MATERIALS AND METHODS 121 patients with advanced stage HNSCC were treated with RT (35 x 2 Gy) and cisplatin (6 mg/m(2) i.v. x20, daily before RT). After 47 patients, the treatment protocol (Standard Group) was changed: Daily i.v. prehydration and accelerated RT were given to the subsequent 74 patients (Hydr-Ac-RT Group). RESULTS Mean follow-up was 29 months (range 7-62). More chemotherapy could be administered in the Hydr-Ac-RT Group (maximum no. of 20 cisplatin-infusions increased from 59% to 91% of patients, p=0.008), with less renal toxicity (p<0.001) and less hospital admissions (p<0.02). However, mucositis was more pronounced and tubefeeding more frequent in the Hydr-Ac-RT Group. The CR rate of the primary tumor increased from 74% (Standard Group) to 90% (Hydr-Ac-RT Group) (p=0.06), although this did not lead to an improvement in loco-regional control. CONCLUSIONS Concurrent chemoradiation with daily low dose cisplatin is feasible and effective for selected patients with advanced HNSCC. Although the addition of accelerated RT resulted in more mucositis and tubefeeding, the introduction of prehydration led to better compliance to therapy with more chemotherapy administered and less hospital admissions.
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Affiliation(s)
- Frank J P Hoebers
- Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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