Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

Abstract

Objective: To describe rates of short-term morbidity following transcervical surgical treatment of hypopharyngeal diverticulum (HD) and analyze predictors of adverse events. Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was queried to identify patients diagnosed with HD undergoing open transcervical diverticulectomy. Results: A total of 597 patients with a mean age of 71.4 ± 12.3 years were included. Thirty-day adverse events were experienced by 63 (10.6%) subjects, including 6.5% unplanned reoperations, 4.2% surgical complications, 4.4% medical complications, 2.7% readmissions, and 0.7% deaths. Medical complications notably included pneumonia (2.0%), reintubation (1.2%), sepsis (1.2%), intubation >48 hours (0.5%), urinary tract infection (0.5%), or deep vein thrombosis (0.5%), while surgical complications included organ/space infection (2.0%) and superficial (1.3%) or deep (1.0%) surgical site infection. Gender, race, functional status, diabetes, dyspnea, hypertension, steroid use, and recent weight loss were not associated with adverse events. Length of operation and hospitalization were both higher among those with adverse events (127.4 ± 107.9 vs 95.7 ± 59.8 minutes, P = 0.027, and 7.4 ± 7.4 vs 2.8 ± 3.6 days, P < 0.001). On multivariable logistic regression, high American Society of Anesthesiologists (ASA) class (OR = 2.02, P = 0.017), smoking (OR = 2.10, P = 0.044), and operation time (OR = 1.01; P = 0.005) were independent predictors of adverse events. Obesity was not associated with length of stay, readmission/reoperation, or complications. However, increased age was associated with shorter operations ( P = 0.020), higher length of hospitalization ( P < 0.001), and higher mortality ( P = 0.027) and readmission rates ( P = 0.023). Conclusion: Understanding clinical factors associated with complications following open surgery for HD such as ASA score, smoking status, length of operation, and age can help optimize surgical outcomes for at-risk patients. Level of Evidence: NA

Malnutrition and Postoperative Outcomes Following Transcervical Zenker Diverticulectomy

“…Surgical management is the first‐line treatment for symptomatic Zenker diverticulum and is commonly performed through an open, transcervical approach 6,7 . Zenker diverticulectomy (ZD), or excision of the diverticulum, is a popular transcervical technique but has been associated with postoperative complications, including pneumonia, sepsis, recurrent nerve palsy, and fistulas 7–9 . Mortality is rare; however, increased age has been associated with greater risk of mortality following ZD 9 .…”

“…6,7 Zenker diverticulectomy (ZD), or excision of the diverticulum, is a popular transcervical technique but has been associated with postoperative complications, including pneumonia, sepsis, recurrent nerve palsy, and fistulas. [7][8][9] Mortality is rare; however, increased age has been associated with greater risk of mortality following ZD. 9 While still common, open approach ZD has lost favor to endoscopic ZD due to its greater invasiveness and severity of complications.…”

“…[7][8][9] Mortality is rare; however, increased age has been associated with greater risk of mortality following ZD. 9 While still common, open approach ZD has lost favor to endoscopic ZD due to its greater invasiveness and severity of complications. 7 There are several methods that surgeons can use to screen for malnutrition in surgical patients, yet it is often underdiagnosed.…”

Assessing the Clinical Utility of the Early Postoperative Pharyngogram in Hypopharyngeal Surgery for Dysphagia

“…Postoperative leaks have been reported in endoscopic diverticulotomy and CPM, and are estimated to occur in 1%–20% of patients treated with open diverticulectomy and CPM 9–12 . A recent review of adverse events in open transcervical ZD repair reported a 1%–2% surgical site infection prevalance 13 . In a large analysis of insurance claims, mediastinitis associated with treatment of ZD occurred in 0.3% of patients undergoing surgical management 7 …”

“…[9][10][11][12] A recent review of adverse events in open transcervical ZD repair reported a 1%-2% surgical site infection prevalance. 13 In a large analysis of insurance claims, mediastinitis associated with treatment of ZD occurred in 0.3% of patients undergoing surgical management. 7 Among dysphagia surgeons and hospital systems performing these surgeries, significant variability exists regarding appropriate postoperative surgical care, risk assessment, and diet advancement.…”