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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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Hsu CM, Yang MY, Tsai MS, Chang GH, Yang YH, Tsai YT, Wu CY, Chang SF. Dihydroisotanshinone I as a Treatment Option for Head and Neck Squamous Cell Carcinomas. Int J Mol Sci 2021; 22:ijms22168881. [PMID: 34445585 PMCID: PMC8396193 DOI: 10.3390/ijms22168881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) are the most common cancers of the head and neck, and their prevalence is rapidly increasing. HNSCCs present a clinical challenge because of their high recurrence rate, therapeutic resistance to radiation and chemotherapy drugs, and adverse effects. Hence, traditional Chinese herbal treatment may be advantageous to therapeutic strategies for HNSCCs. Danshen (Salvia miltiorrhiza), a well-known Chinese herb, has been extensively applied in treatments for various diseases, including cancer, because of its high degree of safety and low rate of adverse effects despite its unclear mechanism. Thus, we aimed to explore the possible anticancer effects and mechanisms of dihydroisotanshinone I (DT), a compound in danshen (extract from danshen), on HNSCCs. Three HNSCCs cell lines were used for in vitro studies, and a Detroit 562 xenograft mouse model was chosen for in vivo studies. Our in vitro results showed that DT could initiate apoptosis, resulting in cell death, and the p38 signaling partially regulated DT-initiated cell apoptosis in the Detroit 562 model. In the xenograft mouse model, DT reduced tumor size with no obvious adverse effect of hepatotoxicity. The present study suggests that DT is a promising novel candidate for anti-HNSCCs therapy.
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Affiliation(s)
- Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-M.H.); (M.-S.T.); (G.-H.C.); (Y.-T.T.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ming-Yu Yang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-M.H.); (M.-S.T.); (G.-H.C.); (Y.-T.T.)
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-M.H.); (M.-S.T.); (G.-H.C.); (Y.-T.T.)
| | - Yao-Hsu Yang
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-M.H.); (M.-S.T.); (G.-H.C.); (Y.-T.T.)
| | - Ching-Yuan Wu
- Department of Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- School of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (C.-Y.W.); (S.-F.C.)
| | - Shun-Fu Chang
- Department of Medical Research and Development, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Correspondence: (C.-Y.W.); (S.-F.C.)
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3
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Lop J, Valero C, García J, Quer M, Ganly I, Shah JP, Patel SG, León X. Does age influence disease-specific survival in patients with squamous cell carcinomas of the head and neck? J Surg Oncol 2020; 121:1058-1066. [PMID: 32153030 DOI: 10.1002/jso.25895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES The number of patients diagnosed with head and neck squamous cell carcinoma (HNSCC) at an advanced age has increased. The aim of this study is to evaluate the age at which disease-specific survival (DSS) significantly decreases in HNSCC. METHODS We performed a retrospective study of 5469 patients with HNSCC treated at our center (1985-2016). External validation with 2082 oral squamous cell carcinomas from a collaborative institution from another continent was performed. RESULTS We observed an orderly decrease in overall survival as age at diagnosis increased. There were no differences in DSS based on age for patients <80 years old (P = .623), while older patients had a significant decrease in DSS. These results were validated in the independent dataset. In a multivariable analysis performed in the test set, compared to patients <80 years old, patients between 80 to 85 had a 1.50 times higher risk of disease-specific death (95% confidence interval [CI]: 1.19-1.89; P = .001), and patients >85 had a 2.19 times higher risk (95% CI: 1.68-2.87; P < .001). CONCLUSIONS DSS started to significantly decrease in HNSCC at 80 years old. These findings, validated in an independent cohort, indicate that chronological age on its own should not withhold curative treatment in the majority of patients with HNSCC.
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Affiliation(s)
- Joan Lop
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Valero
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacinto García
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Quer
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Oncology, Radiotherapy, and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Snehal G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Xavier León
- Department of Otorhinolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Oncogenesis and Antitumor Drugs Group, Biomedical Research Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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4
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Rubin SJ, Wu KY, Kirke DN, Ezzat WH, Truong MT, Salama AR, Jalisi S. Head and Neck Cancer Complications in the Geriatric Population Based on Hospital Case Volume. EAR, NOSE & THROAT JOURNAL 2019; 100:NP62-NP68. [PMID: 31170822 DOI: 10.1177/0145561319856006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine whether surgical case volume is a predictive factor of surgical outcomes when managing geriatric patients with head andneck cancer. METHODS A cross-sectional study design was used. Data were obtainedfrom the Vizient Database, which included a total of 93 academicinstitutions. Men and women aged between 65 and 100 years undergoing head and neck cancer surgery during 2009 and 2012,excluding cases of thyroid cancer and skin cancer of the head and neck(n = 4544) were included in the study. Hospital case volume was definedas low (≤21 cases/year), moderate (22-49 cases/year), or high (≥50 cases/year). The frequency of comorbidities and complications wasmeasured by hospital case volume using a χ2 test. Significancewas determined with an α level of .05. RESULTS The largest number of head and neck cancer cases involving comorbidities (90.54%) and the highest rate of overall complications(27.50%) occurred in moderate case volume institutions compared to athe complication rate of 22.89% in low volume hospitals and 21.50% in highvolume hospitals (P < .0001). The most common comorbidities across all3 hospital case volumes included hypertension, metastatic cancer,and chronic pulmonary disease and the most common complicationsincluded hemorrhage/hematoma and postoperative pulmonarycompromise. CONCLUSION With more geriatric patients requiring surgery for head andneck cancer, it would be beneficial to manage the more complex cases at high volume centers and to develop multidisciplinary teams to optimizecase management and minimize complications.
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Affiliation(s)
- Samuel J Rubin
- Department of Otolaryngology - Head and Neck Surgery, 1836Boston Medical Center, Boston, MA, USA
| | - Kevin Y Wu
- Department of Otolaryngology - Head and Neck Surgery, 1836Boston Medical Center, Boston, MA, USA
| | - Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, 5944Mount Sinai Health System, New York, NY, USA
| | - Waleed H Ezzat
- Department of Otolaryngology - Head and Neck Surgery, 1836Boston Medical Center, Boston, MA, USA
| | - Minh Tam Truong
- Department of Radiation Oncology, 1836Boston Medical Center, Boston, MA, USA
| | - Andrew R Salama
- Department of Oral and Maxillofacial Surgery, 1836Boston Medical Center, Boston, MA, USA
| | - Scharukh Jalisi
- Division of Otolaryngology - Head and Neck Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
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5
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Total pharyngolaryngectomy in the elderly: The impact of age on postoperative complications and oncologic and functional outcomes. Surg Oncol 2018; 27:767-772. [DOI: 10.1016/j.suronc.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/25/2018] [Accepted: 10/10/2018] [Indexed: 11/22/2022]
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6
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Parsemain A, Philouze P, Pradat P, Ceruse P, Fuchsmann C. Free flap head and neck reconstruction: Feasibility in older patients. J Geriatr Oncol 2018; 10:577-583. [PMID: 30497979 DOI: 10.1016/j.jgo.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/02/2018] [Accepted: 11/08/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The main purpose of this study was to evaluate the perioperative morbidity of free flap head and neck reconstructive surgery in patients aged 70 years and over (Group A) by comparison with a cohort of younger patients (Group B). Secondary objectives included assessment of survival rates and functional outcomes in these older patients, likewise by comparison with a cohort of younger patients. METHODS A retrospective study was conducted on all patients aged 70 years and over who underwent free flap reconstruction between 2012 and 2017. They were compared to a control group of younger patients to investigate hospital length of stay, postoperative complications and survival rates, and functional outcomes. RESULTS No significant difference was observed between the two groups in terms of variables such as hospital length of stay and medical/surgical complications. In multivariate analysis, comorbidity was the only predictive factor for postoperative medical complications, and pharyngolaryngeal location the only significant predictive factor for surgical complications. Factors significantly associated with hospital length of stay were older age, active smoking, pharyngolaryngeal location and the Charlson Comorbidity Index (CCI). Overall survival was the only factor that was substantially lower in the over 70 group, while disease-specific and relapse-free survival were comparable in both groups. CONCLUSION Old age per se should not be considered a contraindication to major surgery combined with free flap reconstruction in older patients.
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Affiliation(s)
- Aurélie Parsemain
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Philouze
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Pradat
- Clinical Research Center, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Cancer Research Center of Lyon, UMR Inserm U1052, CNRS 5286, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Philippe Ceruse
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Carine Fuchsmann
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
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7
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de Nadal M, Pérez-Hoyos S, Montejo-González JC, Pearse R, Aldecoa C. Intensive care admission and hospital mortality in the elderly after non-cardiac surgery. Med Intensiva 2018; 42:463-472. [PMID: 29502889 DOI: 10.1016/j.medin.2018.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/08/2018] [Accepted: 01/20/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess whether patient age is independently associated to Intensive Care Unit (ICU) admission after non-cardiac surgery. DESIGN An observational cohort study of the Spanish subset of the European Surgical Outcome Study (EuSOS) was carried out. SETTING Hospitals of the public National Health Care System and private hospitals in Spain. INTERVENTION None. PATIENTS AND METHODS All patients over 16 years of age undergoing inpatient non-cardiac surgery in the participating hospitals during a 7-day period in the month of April 2011 were consecutively included. MAIN VARIABLES OF INTEREST ICU admission rate, factors associated with ICU admission and hospital mortality were assessed using logistic regression analysis and fractional polynomial regression. RESULTS Out of 5412 patients, 677 (12.5%) were admitted to the ICU after surgery. The adjusted odds ratio (95% confidence interval [CI]) for ICU admission was 1.1 (0.8-1.4) for patients aged 65-74 years, 0.7 (0.5-1) for patients aged 75-85 years, and 0.4 (0.2-0.8) for patients over 85 years, respectively. Age, ASA score, grade of surgery (minor, intermediate, major), urgent surgery, surgical specialty, laparoscopic surgery and metastatic disease were independent factors for ICU admission. Global risk-adjusted mortality was 1.4 (95% CI 0.9-2.2). The ASA score, urgent surgery, surgical specialty and diabetes were predictors of hospital mortality. CONCLUSIONS Elderly patients (over 80 years) appear less likely to be admitted to ICU after non-cardiac surgery in Spanish hospitals. There was no significant association between age and postoperative mortality in this cohort.
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Affiliation(s)
- M de Nadal
- Department of Anaesthesiology and Intensive Care, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - S Pérez-Hoyos
- Statistics and Bioinformatics Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | - J C Montejo-González
- Department of Intensive Care, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - R Pearse
- Department of Intensive Care Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - C Aldecoa
- Department of Anaesthesia and Surgical Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain
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8
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Blatt S, Schön H, Sagheb K, Kämmerer PW, Al-Nawas B, Schiegnitz E. Hemoglobin, C-reactive protein and ferritin in patients with oral carcinoma and their clinical significance – A prospective clinical study. J Craniomaxillofac Surg 2018; 46:207-212. [DOI: 10.1016/j.jcms.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
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9
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Xu J, Hu J, Yu P, Wang W, Hu X, Hou J, Fang S, Liu X. Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases. PLoS One 2017; 12:e0188167. [PMID: 29135994 PMCID: PMC5685601 DOI: 10.1371/journal.pone.0188167] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Postoperative pneumonia (POP) is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC) surgery. Methods Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later. Results The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP. Conclusion Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.
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Affiliation(s)
- Jieyun Xu
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jing Hu
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Pei Yu
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Weiwang Wang
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xingxue Hu
- Department of Immunology and Infectious Diseases, the Forsyth Institute, Cambridge, Massachusetts, United States of America
- Division of General Practice and Materials Science, the Ohio State University College of Dentistry, Columbus, Ohio, United States of America
| | - Jinsong Hou
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Silian Fang
- Department of Oral and Maxillofacial Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail: (SF); (XL)
| | - Xiqiang Liu
- Department of Oral Maxillofacial–Head & Neck Oncology, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
- * E-mail: (SF); (XL)
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10
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Nieman CL, Stewart CM, Eisele DW, Pronovost PJ, Gourin CG. Frailty, hospital volume, and failure to rescue after head and neck cancer surgery. Laryngoscope 2017; 128:1365-1370. [PMID: 29044631 DOI: 10.1002/lary.26952] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/14/2017] [Accepted: 09/10/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES/HYPOTHESIS We previously reported that high-volume hospital head and neck cancer (HNCA) surgical care is associated with decreased mortality, largely explained by reduced rates of failure to rescue. Frailty is an independent predictor of mortality, but is significantly less likely in patients receiving high-volume care. We investigate whether differences in frailty rates explain the relationship between volume and outcomes in HNCA patients and whether frailty confounds the relationship between failure to rescue and mortality. STUDY DESIGN Cross-sectional analysis. METHODS Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 were analyzed using cross-tabulations and multivariate regression. Failure to rescue was defined as death after a major complication. Frailty was defined using frailty-defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. RESULTS High-volume hospital care was associated with a lower odds of frailty (odds ratio [OR]: 0.7 [95% confidence interval [CI]: 0.5-1.0]). Frail patients had higher odds of postoperative complications (OR: 4.1 [95% CI: 3.4-4.9]) and mortality (OR: 2.0 [95% CI: 1.3-3.2]), but no difference in failure to rescue rates (OR: 1.0 [95% CI: 0.6-1.6]). High-volume care was not associated with differences in odds of complications (OR: 1.0 [95% CI: 0.8-1.2]), but was associated with significantly decreased odds of mortality (OR: 0.6 [95% CI: 0.5-0.9]) and failure to rescue (OR: 0. 6 [95% CI: 0.3-1.0]), which was not attenuated by adjusting for frailty. CONCLUSIONS High-volume HNCA surgical care is associated with a significantly lower odds of mortality, which appears to be associated with differences in the response to and management of complications rather than differences in frailty or complication rates. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:1365-1370, 2018.
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Affiliation(s)
- Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Johns Hopkins Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Peter J Pronovost
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Health Policy and Management, Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Johns Hopkins Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland
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11
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Nieman CL, Pitman KT, Tufaro AP, Eisele DW, Frick KD, Gourin CG. The effect of frailty on short-term outcomes after head and neck cancer surgery. Laryngoscope 2017; 128:102-110. [DOI: 10.1002/lary.26735] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/14/2017] [Accepted: 05/15/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Carrie L. Nieman
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Maryland U.S.A
- The Johns Hopkins Center on Aging and Health; Johns Hopkins Medical Institutions; Maryland U.S.A
| | - Karen T. Pitman
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Maryland U.S.A
| | - Anthony P. Tufaro
- Department of Plastic and Reconstructive Surgery; Johns Hopkins Medical Institutions; Maryland U.S.A
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Maryland U.S.A
| | - Kevin D. Frick
- Department of Health Policy and Management; The Johns Hopkins Bloomberg School of Public Health; Baltimore Maryland U.S.A
- The Johns Hopkins Carey Business School; Baltimore Maryland U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins Medical Institutions; Maryland U.S.A
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12
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Hartmann S, Grandis JR. Treatment of head and neck cancer in the elderly. Expert Opin Pharmacother 2016; 17:1903-21. [DOI: 10.1080/14656566.2016.1220540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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