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Nikiema JN, Thiam D, Bayani A, Ayotte A, Sourial N, Bally M. Assessing the impact of transitioning to 11th revision of the International Classification of Diseases (ICD-11) on comorbidity indices. J Am Med Inform Assoc 2024; 31:1219-1226. [PMID: 38489540 PMCID: PMC11105143 DOI: 10.1093/jamia/ocae046] [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: 10/10/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES This study aimed to support the implementation of the 11th Revision of the International Classification of Diseases (ICD-11). We used common comorbidity indices as a case study for proactively assessing the impact of transitioning to ICD-11 for mortality and morbidity statistics (ICD-11-MMS) on real-world data analyses. MATERIALS AND METHODS Using the MIMIC IV database and a table of mappings between the clinical modification of previous versions of ICD and ICD-11-MMS, we assembled a population whose diagnosis can be represented in ICD-11-MMS. We assessed the impact of ICD version on cross-sectional analyses by comparing the populations' distribution of Charlson and Elixhauser comorbidity indices (CCI, ECI) across different ICD versions, along with the adjustment in comorbidity weighting. RESULTS We found that ICD versioning could lead to (1) alterations in the population distribution and (2) changes in the weight that can be assigned to a comorbidity category in a reweighting initiative. In addition, this study allowed the creation of the corresponding ICD-11-MMS codes list for each component of the CCI and the ECI. DISCUSSION In common with the implementations of previous versions of ICD, implementation of ICD-11-MMS potentially hinders comparability of comorbidity burden on health outcomes in research and clinical settings. CONCLUSION Further research is essential to enhance ICD-11-MMS usability, while mitigating, after identification, its adverse effects on comparability of analyses.
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Affiliation(s)
- Jean Noel Nikiema
- Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada
- Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, H3N 1X9, Canada
| | - Djeneba Thiam
- Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada
- Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada
| | - Azadeh Bayani
- Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada
- Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada
| | - Alexandre Ayotte
- Systèmes de soins et de santé publique, Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, H3N 1X9, Canada
- Laboratoire Transformation Numérique en Santé (LabTNS), Montréal, Québec, H2X 0A9, Canada
| | - Nadia Sourial
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, H3N 1X9, Canada
- Carrefour de l'innovation, Research Center, Centre hospitalier de l’Université de Montréal, Montréal, Québec, H2X 0A9, Canada
| | - Michèle Bally
- Carrefour de l'innovation, Research Center, Centre hospitalier de l’Université de Montréal, Montréal, Québec, H2X 0A9, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, H3T 1J4, Canada
- Département de Pharmacie, Centre hospitalier de l’Université de Montréal, Montréal, Québec, H2X 0C1, Canada
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Hashimoto M, Fukuokaya W, Yanagisawa T, Yamamoto S, Koike Y, Imai Y, Iwatani K, Onuma H, Ito K, Urabe F, Tsuzuki S, Kimura S, Oyama Y, Abe HI, Miki J, Kimura T. Association between comorbidities and survival in patients with metastatic urothelial carcinoma treated with pembrolizumab. Int J Clin Oncol 2024; 29:612-619. [PMID: 38430304 DOI: 10.1007/s10147-024-02482-7] [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: 08/27/2023] [Accepted: 01/22/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND This study aims to investigate the relationship between comorbidities and survival in patients with mUC treated with pembrolizumab as a second-line treatment. METHODS From February 2018 to October 2021, we analyzed the data of 185 consecutive patients with metastatic UC who received pembrolizumab as second-line therapy at The Jikei University Hospital and five affiliated hospitals. We used the Charlson Comorbidity Index (CCI) to assess the comorbidities. The outcomes of interest were progression-free survival (PFS) and overall survival (OS). To compare the survival differences, inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and the IPTW-adjusted Cox regression hazards model were used. RESULTS After IPTW adjustment, patient characteristics were well-balanced between patients with high CCI and those with low CCI. The IPTW-adjusted Kaplan-Meier curves of PFS and OS based on CCI revealed that the patients with high CCI (2 or more) had a shorter PFS (median, 1.6 vs. 2.8 months) and a shorter OS (median, 12.4 vs. 18.8 months) (0-1). Similarly, in the IPTW-adjusted Cox regression hazards model, patients with high CCI had significantly shorter PFS [HR, 1.84 (95% CI 1.26-2.68; p = 0.002)] and OS [HR, 1.98 (95% CI 1.20-3.27; p = 0.008)] than those with lower CCI. CONCLUSIONS High CCI was associated with a higher risk of disease progression as well as overall mortality in mUC patients treated with second-line pembrolizumab.
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Affiliation(s)
- Masaki Hashimoto
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shutaro Yamamoto
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuhei Koike
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hajime Onuma
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kagenori Ito
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yu Oyama
- Department of Medical Oncology, Kameda Medical Center, Kamogawa, Japan
| | - HIrokazu Abe
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Dang S, Kallogjeri D, Dizdar K, Lee D, Bao JW, Varghese J, Walia A, Zhan K, Youssef S, Durakovic N, Wick CC, Herzog JA, Buchman CA, Piccirillo JF, Shew MA. Individual Patient Comorbidities and Effect on Cochlear Implant Performance. Otol Neurotol 2024; 45:e281-e288. [PMID: 38437816 PMCID: PMC10939851 DOI: 10.1097/mao.0000000000004144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To examine the association between preoperative comorbidities and cochlear implant speech outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included. EXPOSURE Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes. MAIN OUTCOME MEASURES Postoperative change in consonant-nucleus-consonant (CNC) score, AzBio Sentence score in quiet, and AzBio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months. RESULTS A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for AzBio Quiet ( p = 0.045) and AzBio + 10 dB SNR ( p = 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7-58.9) and 32.5 (24.6-40.5), respectively, for AzBio Quiet; 39.5 (33.8-45.2) and 21.2 (13.6-28.7), respectively, for AzBio + 10 dB SNR; and 43.9 (38.7-49.0) and 31.1 (24.8-37.4), respectively, for CNC. CONCLUSIONS Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.
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Affiliation(s)
- Sabina Dang
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | | | - Karmela Dizdar
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - David Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - James W Bao
- Miller School of Medicine, University of Miami, Florida
| | - Jordan Varghese
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Kevin Zhan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Stephanie Youssef
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jacques A Herzog
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Matthew A Shew
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
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Mourgues C, Balayssac D, Mulliez A, Planeix CM, Feydel G, Biard A, Alaux-Boïko V, Irthum C, Saroul N, Dang NP. Comparison of the microvascular anastomotic Coupler™ system with hand-sewn suture for end to end veno-venous anastomosis for head and neck reconstruction with free flap transfer: Medico-economic retrospective case-control study. J Craniomaxillofac Surg 2024; 52:291-296. [PMID: 38212165 DOI: 10.1016/j.jcms.2023.12.014] [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: 06/01/2023] [Revised: 08/08/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024] Open
Abstract
The aim of this study was to assess the medico-economic impact of the MACD Coupler™ system in comparison with HSA for end to end veno-venous anastomosis during free flap transfer. A retrospective case-control study was performed in an academic institution, from March 2019 through July 2021, to analyze medical and economic outcomes of patients managed for head and neck reconstruction with free flap transfer. 43 patients per group were analyzed. Rates of initial success, re-intervention, complications and flap transfer failure were not different between groups. Use of MACD increased the cost of medical devices between Coupler and Control groups with respectively K€ 0.7 [0.5; 0.8] and K€ 0.1 [0.5; 0.8] (p = 0.001) and decreased the cost for operating staff with respectively K€ 4.0 [3.4; 5.2] and K€ 5.1 [3.8; 5.4] (p = 0.03). The total management costs were not different between groups with respectively a total median cost of K€ 18.4 [14.3; 27.2] and K€ 17.3 [14.1; 23.7] (p = 0.03). In conclusion, the cost of the Coupler™ is significant but is partly offset by the decrease in operating staff costs. The choice of one or the other technique can be left to the discretion of the surgeon.
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Affiliation(s)
- Charline Mourgues
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France.
| | - David Balayssac
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France; Université Clermont Auvergne, INSERM U1107, NEURODOL, F-63003, Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Claire-Marie Planeix
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Gabrielle Feydel
- CHU Clermont-Ferrand, Délégation à la recherche clinique et à l'innovation, F-63003, Clermont-Ferrand, France
| | - Adrien Biard
- CHU Clermont-Ferrand, Service Pharmacie, F-63003, Clermont-Ferrand, France
| | - Véra Alaux-Boïko
- CHU Clermont-Ferrand, Service Pharmacie, F-63003, Clermont-Ferrand, France
| | - Charles Irthum
- CHU Clermont-Ferrand, Service de chirurgie maxillo-faciale et plastique, F-63003, Clermont-Ferrand, France
| | - Nicolas Saroul
- CHU Clermont-Ferrand, Service d'Oto-Rhino-Laryngologie et chirurgie cervico-faciale, F-63003, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, INRAE, UNH, Équipe ASMS, 63000, Clermont-Ferrand, France
| | - Nathalie Pham Dang
- Université Clermont Auvergne, INSERM U1107, NEURODOL, F-63003, Clermont-Ferrand, France; CHU Clermont-Ferrand, Service de chirurgie maxillo-faciale et plastique, F-63003, Clermont-Ferrand, France
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Locatello LG, Saitta T, Maggiore G, Signorini P, Pinelli F, Adembri C. A 5-year experience with midline catheters in the management of major head and neck surgery patients. J Vasc Access 2023; 24:1412-1420. [PMID: 35441553 DOI: 10.1177/11297298221091141] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In the perioperative management of major head and neck surgery (HNS) patients, the performance of midline catheters (MCs) has been never tested. We present here our 5-year experience by reporting MC-related complications and by identifying the preoperative risk factors associated with their development. METHODS Clinical variables were extracted and the dwell time, the number, and the type of postprocedural complications of MCs were retrieved. Complications were classified into major (needing MCs removal and including catheter-related bloodstream infection or deep vein thrombosis or catheter occlusion) and into minor (accidental dislodgement, leaking, etc.). Descriptive statistics and logistic regression models were used in order to identify the predictors of complications. RESULTS A total of 265 patients were included, with a mean age of 67.4 years. Intraprocedural complications occurred in 1.1% of cases, while postprocedural complications occurred in 13.9% of cases (12.05/1000 days), but they were minor in more than 7.0% (5.4/1000 catheter-days). There were 19 minor complications (7.1% or 5.4/1000 catheter-days) while 18 (7%, 5.1/1000 catheter-days) patients experienced at least one major complication. Female sex (OR = 1.963, 95% CI 1.017-3.792), insertion in the right arm (OR = 2.473, 95% CI 1.150-5.318), and an ACE-27 score >1 (OR = 2.573, 95% CI 1.295-5.110) were independent predictors of major complications. CONCLUSIONS MCs appear to represent an effective option in the setting of major HNS. The identification of patients most at risk for MC-related complications should prompt a postoperative watchful evaluation.
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Affiliation(s)
| | - Thomas Saitta
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Patrizia Signorini
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Fulvio Pinelli
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Chiara Adembri
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
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Li D, Niu Q, Wang C, Wei W, Li B, Liu H, Xiao R, Wang H, Xu Q, Han Z, Feng Z. Comprehensive complication index: A new reporting standard for postoperative complications of free-flap reconstruction in head and neck cancer patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:33-41. [PMID: 35985962 DOI: 10.1016/j.oooo.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/12/2022] [Accepted: 05/13/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We aimed to validate and evaluate the comprehensive complication index (CCI) as a measure of postoperative complications (POCs) in the patients with head and neck squamous cell carcinoma (HNSCC) who had undergone free-flap reconstruction. STUDY DESIGN A single-center, prospective cohort study was conducted on the patients with primary HNSCC treated between 2015 and 2020. RESULTS Of 443 patients, 177 experienced POCs (40.0%). According to the new CCI, 93 patients had severe POCs (score ≥26.2; 21.0%), and only 76 patients were classified as having severe POCs (grade ≥III; 17.2%) according to the traditional Clavien-Dindo classification (CDC). The patients with CCI scores ≥26.2 had a higher rate of major adverse short-term outcomes, such as prolonged length of the hospital stay after surgery, excessive medical costs, and the need for transfusion. Importantly, the Kaplan-Meier analysis revealed a lower overall survival rate for patients with severe complications (CCI score ≥26.2, P = .038). However, no statistically significant differences were observed between CDC grades III or above and overall survival (P = .100). CONCLUSIONS The CCI can be used to evaluate POCs of free-flap reconstruction in patients with HNSCC. It performed more accurately than the CDC in short- and long-term outcome prediction and risk factor identification.
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Affiliation(s)
- Delong Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Qifang Niu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Chong Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Huan Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Ranran Xiao
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Qiaoshi Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
| | - Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
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Runge A, Vales A, Pommer G, Raab H, Prossliner H, Randhawa A, Schennach H, Riechelmann H. Perioperative Blood Transfusion in Head and Neck Cancer Revisited. Laryngoscope 2022. [PMID: 37021734 DOI: 10.1002/lary.30341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To reevaluate the frequency of perioperative blood transfusion, transfusion triggers, and survival impact in patients with incident, surgically treated head and neck cancer (HNC) in restrictive transfusion regimens. METHODS Retrospective analysis of surgically treated patients with incident HNC with and without perioperative blood transfusion between 2008 and 2019 at the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, according to the department's clinical Head and Neck Tumor Registry. RESULTS Of the 590 patients included, perioperative transfusions were administered in 6.3% (n = 37, transfusion group). Following multivariable logistic regression, likelihood of blood transfusions was increased in patients with poorer general health conditions (ASA score III/IV; OR 3.7; 95% CI 1.9-8.6; p = 0.002), hemoglobin <12.5 g/dL (OR 2.7; 95% CI 1.1-6.4; p = 0.03), longer duration of surgery (OR 1.006 per minute of surgery time; 95% CI 1.003-1.008; p < 0.001), and negative p16 status (OR 5.3; 95% CI = 1.1-25; p = 0.03). Based on 14 matching variables related to survival and perioperative blood transfusion, a control group of 37 matching patients without perioperative transfusion was identified. Using univariate analysis, overall survival in transfusion and control groups did not differ significantly (p = 0.25). After adjusting for four parameters with limited matching accuracy (Chi square p < 0.2) in Cox regression analysis, a transfusion related hazard ratio close to 1 (HR 0.92; 95% CI 0.34-2.51; p = 0.87) was observed. CONCLUSION Considering current restrictive transfusion regimens and general transfusion risks, the administration of blood products in HNC patients during the perioperative period is not associated with additional oncologic hazard. LEVEL OF EVIDENCE III Laryngoscope, 2022.
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Affiliation(s)
- Annette Runge
- Department of Otorhinolaryngology, Head and Neck Surgery Medical University of Innsbruck Innsbruck Austria
| | - Anja Vales
- Institute for Blood Transfusion and Immunological Department Medical University of Innsbruck Innsbruck Austria
| | - Gabriele Pommer
- Department of Otorhinolaryngology, Head and Neck Surgery Medical University of Innsbruck Innsbruck Austria
| | - Helmut Raab
- Department of Anesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Harald Prossliner
- Department of Anesthesiology and Intensive Care Medicine Medical University of Innsbruck Innsbruck Austria
| | - Avneet Randhawa
- Department of Otolaryngology – Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Harald Schennach
- Institute for Blood Transfusion and Immunological Department Medical University of Innsbruck Innsbruck Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Head and Neck Surgery Medical University of Innsbruck Innsbruck Austria
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Davis KP, Kompelli A, Gardner JR, Mohler S, Gammill S, King D, Vural E, Sunde J, Moreno MA. Postoperative and 1-Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older. Otolaryngol Head Neck Surg 2022; 167:41-47. [PMID: 35290129 DOI: 10.1177/01945998221083592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the postoperative and 1-year functional outcomes after free flap surgery among patients ≥80 years old. STUDY DESIGN Retrospective chart review. SETTING Single tertiary care center. METHODS We conducted a retrospective review of 596 patients who underwent head and neck ablation and reconstruction with free tissue over a 7-year period. Patients ≥80 years of age were included. RESULTS Fifty patients were ≥80 years old, with an average age of 83.7 years. Ninety-day mortality was 12.0%, and those who died were of older age (87.5 vs 83.1 years, P = .036). Prior radiation therapy (odds ratio, 6.8 [95% CI, 1.1-42.7]) and a Charlson Comorbidity Index ≥3 (odds ratio, 10.0 [95% CI, 1.5-67.0]) were associated with an increased risk of 90-day mortality. Overall 21 (42.0%) patients experienced a 30-day complication; 7 (14.0%) were readmitted within 30 days; and 5 (10.0%) underwent additional flap-related operations. Flap failure occurred in 2 (4.0%) patients. Before surgery, 45 (90%) patients were living independently or within assisted living; among these, 19.5% declined to dependent functional status at 90-day follow-up. At 90 days, 2 (8.3%) of 24 patients remained tracheostomy dependent, and 20 (66.7%) of 30 patients required feeding tube supplementation. Among 42 patients, 36 (85.7%) had unrestricted or modified oral diets at 90 days. Charlson Comorbidity Index ≥2 was associated with an increased risk of 1-year mortality (odds ratio, 5.1 [95% CI, 1.4-18.6]). CONCLUSION The potential for functional decline and risk of 90-day mortality should be discussed with patients aged ≥80 years.
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Affiliation(s)
- Kyle P Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anvesh Kompelli
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Samantha Mohler
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sarah Gammill
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deanne King
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Emre Vural
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jumin Sunde
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mauricio Alejandro Moreno
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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