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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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Dodd AC, Lakomkin N, Sathiyakumar V, Obremskey WT, Sethi MK. Do orthopaedic trauma patients develop higher rates of cardiac complications? An analysis of 56,000 patients. Eur J Trauma Emerg Surg 2016; 43:329-336. [PMID: 26907362 DOI: 10.1007/s00068-016-0649-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/08/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Less than 5 % of orthopaedic patients develop postoperative cardiac complications; however, there are little data suggesting which orthopaedic patients are at greatest risk. In an era where emerging reimbursement models place an emphasis on quality, reducing complications through perioperative planning will be of paramount importance for orthopaedic surgeons. The purpose of this study was to determine whether orthopaedic trauma patients are at greater risk for postoperative cardiac complications and to reveal which factors are most predictive of these complications. METHODS All orthopaedic patients were identified in the 2006-2013 ACS-NSQIP database. Cardiac complications were defined as cardiac arrests or myocardial infarctions within 30 days following surgery. Chi squared analysis determined differences in cardiac complication rates between trauma and non-trauma patients. Bivariate analysis incorporating over 40 patient/surgical characteristics determined significant associations between patient characteristics and cardiac complications. These factors were incorporated into a multivariate regression model to identify predictive risk factors for cardiac complications. RESULTS The presence of a traumatic injury resulted in greater odds of developing cardiac complications (OR: 1.645, p < 0.001). The cardiac complication rate in the trauma group was 1.3 % compared to 0.3 % in the non-trauma group (p < 0.001). For trauma patients, ventilator use (OR: 27.354, p = 0.004), recent transfusion (OR: 19.780, p = 0.001), and history of coma (OR: 17.922, p = 0.020) were most predictive of cardiac complications. CONCLUSION Orthopaedic trauma patients are more likely to develop cardiac complications than non-trauma patients. To reduce cardiac complications, orthopaedic traumatologists should be aware of patient risk factors including ventilator use, blood transfusion, and history of coma.
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Affiliation(s)
- A C Dodd
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - N Lakomkin
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - V Sathiyakumar
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - W T Obremskey
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA
| | - M K Sethi
- The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
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