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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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Mukherjee A, Wiener HW, Griffin RL, Lenneman C, Chatterjee A, Nabell LM, Lewis CE, Shrestha S. Traditional risk factors and cancer-related factors associated with cardiovascular disease risk in head and neck cancer patients. Front Cardiovasc Med 2023; 9:1024846. [PMID: 36712282 PMCID: PMC9877509 DOI: 10.3389/fcvm.2022.1024846] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Background Risk of incident cardiovascular disease (CVD) in head and neck squamous cell carcinoma (HNSCC) patients is under-reported. We assessed the association of HNSCC-related factors and traditional risk factors with 1- and 5-year CVD risk in HNSCC patients without prevalent CVD at cancer diagnosis. Methods A clinical cohort of 1,829 HNSCC patients diagnosed between 2012 and 2018, at a National Cancer Institute (NCI)-designated cancer center was included. Information on HNSCC-related factors [HNSCC anatomical subsite, stage at diagnosis, treatment, and tumor human papillomavirus (HPV) status] were extracted from the tumor registry. Data on traditional risk factors (hypertension, dyslipidemia, diabetes, tobacco smoking status, and obesity) were extracted from the electronic health records system (EHR) at baseline (HNSCC diagnosis). A composite of ischemic heart disease, heart failure, and ischemic stroke was the outcome of interest in time to event analysis. Hazard ratio (HR) (95% CI) were reported with death as a competing risk. Results In patients diagnosed with HNSCC, 10.61% developed incident CVD events by 1-year post cancer diagnosis. One-year CVD risk was lower in patients using antihypertensive medications at baseline, compared to patients without baseline hypertension [HR (95% CI): 0.41 (0.24-0.61)]. One-year CVD risk was high in patients receiving HNSCC surgery. Patients receiving radiation therapy had a higher 5-year CVD risk than surgery patients [HR (95% CI): 2.17 (1.31-3.04)]. Patients using antihypertensive medications had a lower 5-year CVD risk than patients without baseline hypertension [HR (95% CI): 0.45 (0.22-0.75)]. Older age and diabetes were associated with increased 1- and 5-year CVD risk. HPV-negative patients were older (p 0.006) and had a higher 5-year cumulative incidence of CVD (p 0.013) than HPV-positive patients. Conclusion Traditional risk factors and cancer-related factors are associated with CVD risk in HNSCC patients. Future research should investigate the role of antihypertensive medications in reducing CVD risk in HNSCC patients.
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Affiliation(s)
- Amrita Mukherjee
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States,Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States,*Correspondence: Amrita Mukherjee,
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Russell L. Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Carrie Lenneman
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Arka Chatterjee
- Department of Medicine, Sarver Heart Center, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Lisle M. Nabell
- Division of Hematology and Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
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3
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Sou WK, Perng CK, Ma H, Shih YC. Perioperative Myocardial Infarction in Free Flap for Head and Neck Reconstruction. Ann Plast Surg 2022; 88:S56-S61. [PMID: 35225848 DOI: 10.1097/sap.0000000000003070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a postoperative complication of major surgical procedures, including free flap surgery. It is the most common cause of postoperative morbidity and mortality. Moreover, patients receiving free flap reconstruction for the head and neck have significant risk factors such as coexisting coronary artery disease (CAD). Our primary aim was to ascertain predictors of perioperative AMI to enable early detection and consequently early treatment of perioperative AMI. Our secondary aim was to determine the group of patients who would be at a high risk for perioperative AMI after free flap surgery. MATERIALS AND METHODS This retrospective study enrolled patients who underwent free flap reconstruction surgery at the Division of Plastic and Reconstructive Surgery of Taipei Veterans General Hospital between 2013-01 and 2017-12. RESULTS This study included 444 patients and 481 free flap head and neck reconstruction surgeries. Fifteen (3.1%) patients were diagnosed with perioperative AMI. Statistical analysis of the variables revealed that patients with underlying CAD or cerebrovascular accident (CVA) were at a high risk of developing perioperative AMI (odds ratio: 6.89 and 11.11, respectively). The flap failure rate was also higher in patients with perioperative AMI compared with those without perioperative AMI (P = 0.015). CONCLUSIONS Patients with underlying diseases, such as CAD or CVA, constituted high-risk groups for perioperative AMI.
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4
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Ziegler A, Schneider A, Pittman A, Thorpe E. Postoperative Tachycardia in Head and Neck Microvascular Free Flap Patients. Otolaryngol Head Neck Surg 2019; 160:1019-1022. [DOI: 10.1177/0194599819827816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The goal of this study was to determine the incidence of postoperative tachycardia and its predictive value of complications in patients following microvascular free flap surgery in the head and neck. Study Design Retrospective chart review. Setting Single tertiary care academic medical center. Subjects and Methods All patients who underwent a microvascular free flap of the head and neck by surgeons in the department of otolaryngology from 2013 to 2017 were included in this study. Results Of the 344 who patients met inclusion criteria, 40.4% had a maximum heart rate (HR) of the hospitalization over 110 beats per minute (bpm). Patients with a maximum HR greater than 110 bpm were 19 times more likely to experience a composite vascular complication (myocardial infarction, myocardial necrosis, or pulmonary embolism) than patients with a maximum HR <110 bpm ( P = .0063). Patients with a history of chronic kidney disease were also noted to have an increased risk of experiencing a postoperative composite vascular event. Conclusion Postoperative tachycardia is significantly associated with adverse outcomes and should not be dismissed as a normal variant. Identifying patients at an increased risk of having an underlying complication can help guide interpretation, workup, and management of postoperative patients in the head and neck population.
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Affiliation(s)
- Andrea Ziegler
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Alexander Schneider
- Department of Otolaryngology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Amy Pittman
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Eric Thorpe
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, USA
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5
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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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6
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Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery. Otolaryngol Head Neck Surg 2018; 159:817-823. [DOI: 10.1177/0194599818777240] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.
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7
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Kim J, So E, Kim HJ, Seo KS, Karm MH. Cardiac arrest due to an unexpected acute myocardial infarction during head and neck surgery: A case report. J Dent Anesth Pain Med 2018; 18:57-64. [PMID: 29556560 PMCID: PMC5858010 DOI: 10.17245/jdapm.2018.18.1.57] [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: 02/01/2018] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 11/15/2022] Open
Abstract
Major cardiac complication such as acute myocardial infarction can occur unexpectedly in patients without risk factors. We experienced cardiac arrest due to an unexpected acute myocardial infarction in a patient without any risk factors during head and neck reconstructive surgery. The patient was diagnosed with acute myocardial infarction after return of spontaneous circulation. With immediate percutaneous coronary intervention, the patient recovered without complications.
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Affiliation(s)
- Jimin Kim
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Eunsun So
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
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8
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Ghazali N, Caldroney S, Dyalram D, Lubek JE. Cardiovascular complications in head & neck microvascular flap reconstruction: A retrospective risk stratification and outcomes assessment. J Craniomaxillofac Surg 2017; 45:2120-2127. [PMID: 29126769 DOI: 10.1016/j.jcms.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction. METHODS A series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson Comorbidity Index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes. RESULTS Twenty patients developed CC (9.7%) with transient cardiac arrhythmia (6.5%) and myocardial infarction (2.8%) occurring most frequently. Univariate analyses demonstrated significant differences between the two groups in terms of their age, smoking status, occurrence of peripheral vascular disease, CCI, RCRI, length of hospitalization and duration of anesthesia. Multivariate analyses showed that RCRI (p < 0.001) and amount of blood transfused (p = 0.02) were independent predictors of CC. CONCLUSIONS Cardiac complications are uncommon in head and neck microvascular flap surgery. The RCRI is a useful screening tool for estimating cardiac complication risk and improving patient and flap outcomes.
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Affiliation(s)
- Naseem Ghazali
- Department of Oral & Maxillofacial Surgery, University of Maryland, 650 West Baltimore Street, Baltimore, MD 21201, USA
| | - Steven Caldroney
- Department of Oral & Maxillofacial Surgery, University of Maryland, 650 West Baltimore Street, Baltimore, MD 21201, USA
| | - Donita Dyalram
- Department of Oral & Maxillofacial Surgery, University of Maryland, 650 West Baltimore Street, Baltimore, MD 21201, USA
| | - Joshua E Lubek
- Department of Oral & Maxillofacial Surgery, University of Maryland, 650 West Baltimore Street, Baltimore, MD 21201, USA.
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9
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Ha W, Kim KN, Ann SH, Yoon CS. Sudden Cardiac Death with Myocardial Infarction after Free-flap Lower Extremity Reconstruction. Chin Med J (Engl) 2017; 130:499-500. [PMID: 28218229 PMCID: PMC5324392 DOI: 10.4103/0366-6999.199830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Won Ha
- Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyu Nam Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, DaeJon, Korea
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chi Sun Yoon
- Department of Plastic and Reconstructive Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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10
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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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11
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Tighe D, Sassoon I, Kwok A, McGurk M. Is benchmarking possible in audit of early outcomes after operations for head and neck cancer? Br J Oral Maxillofac Surg 2014; 52:913-21. [PMID: 25218315 DOI: 10.1016/j.bjoms.2014.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/26/2014] [Indexed: 11/18/2022]
Abstract
There is a need for a validated means of adjusting for case mix in morbidity audits of patients with cancer of the head and neck. To address this, we did a multicentre audit of 3 U.K. NHS cancer networks that treat patients with head and neck cancer, to compare the incidence of early adverse postoperative outcomes and to develop a means of adjusting for case mix. We did a retrospective and prospective audit of the case notes of 901 consecutive patients who had 1034 operations for squamous cell carcinoma (SCC) of the head and neck under general anaesthesia at 3 NHS hospitals. Analysis of raw data showed postoperative 30-day mortality (n=17) to be consistent between sites (1.7%-1.9%) but 30-day complication rates varied more (34%-49%). Logistic regression models predicting morbidity discriminated well (area under the curve 0.74-0.76). Adjusted morbidity rates for the 3 units were compared on a funnel plot with 95% and 99% confidence intervals to account for random variation. It is possible to benchmark surgical performance by focusing on early postoperative outcomes in head and neck surgery. Morbidity is common and usually has a considerable impact on recovery, bed occupancy, cost, and the patient's perception of the quality of care.
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Affiliation(s)
- David Tighe
- Department of Oral and Maxillofacial Surgery, Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex BN21 2UD, UK.
| | - Isabel Sassoon
- Dept of Informatics, King's College Hospital, London, UK.
| | - A Kwok
- Dept of Oral & Maxillofacial Surgery, Guys' Hospital, London, UK.
| | - Mark McGurk
- Oral & Maxillofacial Surgery, Guys' Hospital, London, UK.
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12
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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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13
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Pohlenz P, Klatt J, Schmelzle R, Li L. The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology. Br J Oral Maxillofac Surg 2013; 51:508-13. [PMID: 23369783 DOI: 10.1016/j.bjoms.2012.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022]
Abstract
Mortality is a rare but disastrous complication of microvascular head and neck reconstruction. The investigators attempt to identify the procedure-related mortality cases and analyse the causes of death. A retrospective analysis of 804 consecutive free flap procedures during a 19-year period was performed and fatal cases were identified (n=42 deaths). Multivariate logistic regression was employed to determine the association of in-hospital mortality with patient-related characteristics. The 30-day post-operative mortality rate was 1% (8 out of 804 patients), and the in-hospital mortality rate (post-operative deaths in-hospital before or after the 30th post-operative day without discharge) was 5.2% (42 out of 804 patients). Cancer recurrence and metastases related pneumonia were the most common causes of death (n=26, 62%), followed by cardiac, pulmonary, infectious and hepatic/renal aetiologies. Logistic regression analysis revealed that patients with stage IV disease and an operation time of >9h were significantly associated with post-operative mortality. Malignancy-related conditions were the most common causes of death following free flap transfer for head and neck reconstruction. For patients with stage IV head and neck cancer, this aggressive surgical approach should be cautiously justified due to its association with post-operative mortality. To shorten the operation time, experienced microsurgical operation teams are necessary.
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Affiliation(s)
- P Pohlenz
- Department of Plastic and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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14
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Brandes IF, Müller C, Perl T, Russo SG, Bauer M, Bräuer A. [Efficacy of a novel warming blanket: prospective randomized trial]. Anaesthesist 2013; 62:137-42. [PMID: 23404220 DOI: 10.1007/s00101-013-2140-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perioperative hypothermia is a common complication of general anesthesia and occurs in up to 50 % of patients during ear, nose and throat (ENT) surgery. In this prospective, randomized controlled study the hypothesis that a new conductive warming blanket (Barrier® EasyWarm®, Mölnlycke Health Care Erkrath, Germany) is better in reducing the incidence of perioperative hypothermia in ENT surgery than insulation with a conventional hospital duvet alone was tested. MATERIALS AND METHODS After approval of the local ethics committee and written informed consent 80 patients with a planned procedure time between 1 and 3 h were recruited. Anesthesia was induced and maintained using propofol, remifentanil and rocuronium and the core temperature was measured using an esophageal temperature probe. Patients in the study group were warmed at least 30 min prior to induction of anesthesia using the novel warming blanket (Barrier® EasyWarm®) and patients in the control group were insulated with a standard hospital duvet. Data were tested using Fisher's exact test, Student's t-test or the Mann-Whitney U-test as appropriate. Time-dependent changes in core temperature were evaluated using repeated measures analysis of variance (ANOVA) and post hoc Scheffé's test. Results are expressed as mean ± SD or as median and interquartile range (IQR) as appropriate. A p < 0.05 was considered to be statistically significant. RESULTS The ANOVA did not identify a significantly higher core temperature in the study group at any time point. Furthermore, Fisher's exact test showed no differences in the incidence of intraoperative (12 out of 29 versus 10 out of 32 patients, p = 0.44) or postoperative hypothermia (12 out of 29 versus 9 out of 32 patients, p = 0.30) between the groups. No adverse effects were observed. CONCLUSIONS In the studied patient group the new conductive warming blanket (Barrier® EasyWarm®) showed no superiority compared to conventional thermal insulation alone.
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Affiliation(s)
- I F Brandes
- Abteilung Anaesthesiologie, Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Pereira CMB, Figueiredo MEL, Carvalho R, Catre D, Assunção JP. Anesthesia and Surgical Microvascular Flaps. Rev Bras Anestesiol 2012; 62:563-79. [DOI: 10.1016/s0034-7094(12)70156-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 09/05/2011] [Indexed: 11/27/2022] Open
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Abstract
Abstract
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17
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Ryan L, Rodseth RN, Biccard BM. The treatment of perioperative myocardial infarctions following noncardiac surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2012. [DOI: 10.1080/22201173.2012.10872832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- L Ryan
- Perioperative Research Unit, Department of Anaesthetics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | - RN Rodseth
- Perioperative Research Unit, Department of Anaesthetics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
- Inkosi Albert Luthuli Central Hospital, Mayville
| | - BM Biccard
- Perioperative Research Unit, Department of Anaesthetics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
- Inkosi Albert Luthuli Central Hospital, Mayville
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18
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Ryan L, Rodseth R, Biccard B. Peri-operative myocardial infarction: time for therapeutic trials. Anaesthesia 2011; 66:1083-7. [DOI: 10.1111/j.1365-2044.2011.06984.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Nagele P, Rao LK, Penta M, Kallogjeri D, Spitznagel EL, Cavallone LF, Nussenbaum B, Piccirillo JF. Postoperative myocardial injury after major head and neck cancer surgery. Head Neck 2010; 33:1085-91. [PMID: 20886662 DOI: 10.1002/hed.21577] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 06/10/2010] [Accepted: 07/09/2010] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patients with head and neck cancer often have multiple risk factors for coronary artery disease. Yet, little is known about the incidence of postoperative myocardial injury after major head and neck cancer surgery and its clinical relevance. The aim of this study was to determine the risk of postoperative myocardial injury in patients undergoing major head and neck cancer surgery. METHODS This was a retrospective cohort study of all patients who underwent major head and neck cancer surgery (n = 378) at a single major academic center from April 2003 to July 2008. Peak postoperative troponin I (TnI) concentration was the primary outcome. RESULTS Of 378 patients who underwent major head and neck cancer surgery, 57 patients (15%) had development of an elevated TnI; 90% of these occurred within the first 24 hours after surgery. Preexisting renal insufficiency (unadjusted OR [OR]: 4.60; 95% CI 1.53-13.82), coronary artery disease (OR: 2.33; 95% CI 1.21-4.50), peripheral vascular disease (OR: 2.83; 95% CI 1.31-6.14), hypertension (OR: 2.22; 95% CI 1.20-4.12), and previous combined chemotherapy and radiation (OR: 2.68; 95% CI 1.04-6.91) were associated with elevated postoperative TnI levels. Patients with elevated TnI levels had a significantly longer length of stay in the hospital (8.5 vs 10.1 days; p = .014) and ICU (3 vs 4.5 days; p = .001) and an 8-fold increased risk of death at 60 days after surgery (adjusted OR: 8.01, 95% CI 2.03-31.56). At 1 year, patients with an abnormal postoperative TnI level were twice as likely to die (OR 1.93; 95% CI 1.02-3.63). CONCLUSIONS Patients who undergo major head and neck cancer surgery are at significant risk for postoperative myocardial injury, which is a strong predictor of 60-day mortality after surgery. Monitoring of myocardial injury during the first postoperative days, as well as optimizing preventive cardiac care, may be helpful to reduce postoperative mortality rates.
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Affiliation(s)
- Peter Nagele
- Department of Anesthesiology, Washington University, St. Louis, MO 63110, USA.
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Pattani KM, Byrne P, Boahene K, Richmon J. What makes a good flap go bad?: A critical analysis of the literature of intraoperative factors related to free flap failure. Laryngoscope 2010; 120:717-23. [DOI: 10.1002/lary.20825] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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21
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Incidence and Significance of Myocardial Injury After Surgical Treatment of Head and Neck Cancer. Laryngoscope 2007. [DOI: 10.1097/mlg.0b013e3180ca7863] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Arosarena OA. Perioperative Management of the Head and Neck Cancer Patient. J Oral Maxillofac Surg 2007; 65:305-13. [PMID: 17236939 DOI: 10.1016/j.joms.2005.10.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 07/22/2005] [Accepted: 10/08/2005] [Indexed: 11/19/2022]
Affiliation(s)
- Oneida A Arosarena
- Department of Otolaryngology, Temple University, Philadelphia, PA 19140, USA.
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Rosenthal E, Carroll W, Dobbs M, Scott Magnuson J, Wax M, Peters G. Simplifying head and neck microvascular reconstruction. Head Neck 2005; 26:930-6. [PMID: 15508120 DOI: 10.1002/hed.20076] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. METHODS This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. RESULTS Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. CONCLUSIONS This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results.
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Affiliation(s)
- Eben Rosenthal
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, 1501 5th Avenue South, Birmingham, AL 35249, USA.
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