Above and Beyond Age: Prediction of Major Postoperative Adverse Events in Head and Neck Surgery

Abstract

Objective: Major postoperative adverse events (MPAEs) following head and neck surgery are not infrequent and lead to significant morbidity. The objective of this study was to ascertain which factors are most predictive of MPAEs in patients undergoing head and neck surgery. Methods: A cohort study was carried out based on data from patients registered in the National Surgical Quality Improvement Program (NSQIP) from 2006 to 2018. All patients undergoing non-ambulatory head and neck surgery based on Current Procedural Terminology codes were included. Perioperative factors were evaluated to predict MPAEs within 30-days of surgery. Age was classified as both a continuous and categorical variable. Retained factors were classified by attributable fraction and C-statistic. Multivariate regression and supervised machine learning models were used to quantify the contribution of age as a predictor of MPAEs. Results: A total of 43 701 operations were analyzed with 5106 (11.7%) MPAEs. The results of supervised machine learning indicated that prolonged surgeries, anemia, free tissue transfer, weight loss, wound classification, hypoalbuminemia, wound infection, tracheotomy (concurrent with index head and neck surgery), American Society of Anesthesia (ASA) class, and sex as most predictive of MPAEs. On multivariate regression, ASA class (21.3%), hypertension on medication (15.8%), prolonged operative time (15.3%), sex (13.1%), preoperative anemia (12.8%), and free tissue transfer (9%) had the largest attributable fractions associated with MPAEs. Age was independently associated with MPAEs with an attributable fraction ranging from 0.6% to 4.3% with poor predictive ability (C-statistic 0.60). Conclusion: Surgical, comorbid, and frailty-related factors were most predictive of short-term MPAEs following head and neck surgery. Age alone contributed a small attributable fraction and poor prediction of MPAEs. Level of evidence: 3

Neutrophil‐to‐lymphocyte ratio as a predictor of surgical outcomes in head and neck cancer

“…We identified 20 740 cases of head and neck cancer surgery based on Current Procedural Terminology (CPT) codes that were previously published, with some adjustments made by an expert head and neck cancer surgeon on our study team (SAR). 9 We linked these cases to data from Veterans Health Affairs (VA) databases to obtain patient demographics, surgical information, comorbidities, and laboratory data. We excluded subsequent surgeries, cases with missing NLR data between 1 and 90 days prior to surgery, and surgery types with <50 cases (hypopharyngectomy).…”

Malnutrition and Postoperative Outcomes Following Transcervical Zenker Diverticulectomy

“…Fang et al discovered that the Geriatric Nutritional Risk Index, which incorporates serum albumin levels to determine malnutrition, predicted adverse outcomes in patients after total joint arthroplasty 10 . Furthermore, in Otolaryngology, Mascarella et al noted hypoalbuminemia as a significant predictor of major postoperative adverse events in patients undergoing non‐ambulatory head and neck surgery 16 . Across surgical specialties and within head and neck surgery, hypoalbuminemia has been frequently linked to postoperative complications 10,16 …”

“…Furthermore, in Otolaryngology, Mascarella et al noted hypoalbuminemia as a significant predictor of major postoperative adverse events in patients undergoing non‐ambulatory head and neck surgery 16 . Across surgical specialties and within head and neck surgery, hypoalbuminemia has been frequently linked to postoperative complications 10,16 …”

“…10 Furthermore, in Otolaryngology, Mascarella et al noted hypoalbuminemia as a significant predictor of major postoperative adverse events in patients undergoing nonambulatory head and neck surgery. 16 Across surgical specialties and within head and neck surgery, hypoalbuminemia has been frequently linked to postoperative complications. 10,16 The risk of malnutrition is increased in patients with Zenker diverticulum and hypoalbuminemia can be used by surgeons to preoperatively screen for malnourished patients.…”

“…16 Across surgical specialties and within head and neck surgery, hypoalbuminemia has been frequently linked to postoperative complications. 10,16 The risk of malnutrition is increased in patients with Zenker diverticulum and hypoalbuminemia can be used by surgeons to preoperatively screen for malnourished patients. Boucher et al conducted a single-center retrospective study with 30 patients assessing the role of malnutrition, with hypoalbuminemia as part of the criteria, in patients treated for Zenker diverticulum.…”