Laryngectomy and smoking: An analysis of postoperative risk

Brady, Jacob S.; Crippen, Meghan M.; Filimonov, Andrey; Eloy, Jean Anderson; Baredes, Soly; Park, Richard Chan Woo

doi:10.1002/lary.26615

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…Although some series have shown that smoking is associated with higher rates of surgical and medical complications, 27,28 other studies regarding head and neck surgical resection and free-flap reconstruction have not found smoking to be a significant independent predictor of surgical complications. 15,29 Last, prior disease or receipt of RT were not found to significantly increase the risk of overall or wound complications on univariate analysis or in multivariate models, which other studies similarly have found. 30,31 Multivariate analysis of LOS demonstrated that only UADT surgery, compared with cutaneous surgery, was an independent predictor.…”

Section: Discussionmentioning

confidence: 58%

Impact of neoadjuvant chemotherapy on perioperative morbidity after major surgery for head and neck cancer

Kiong

Lin

Yao

et al. 2020

Cancer

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Background Neoadjuvant chemotherapy (NAC) has been used in patients with advanced head and neck cancers (HNCs) with the intent of downstaging tumors and suppressing distant metastases. However, to the authors' knowledge, the perioperative impact of NAC has not been systematically explored in patients with HNC. The objective of the current study was to compare perioperative outcomes with surgery upfront compared with patients treated with NAC. Methods Between March 1, 2016, and March 31, 2019, patients undergoing surgery for HNC with flap reconstruction at The University of Texas MD Anderson Cancer Center in Houston were included. Data were extracted from the prospectively maintained National Surgical Quality Improvement Program database. Postoperative complications, return to operating room, and readmission rates were compared. Univariate and multivariate analyses of length of stay and overall and wound complications were performed. Results A total of 834 patients were analyzed, 687 of whom (82.4%) underwent surgery upfront and 147 of whom (17.6%) received NAC. A total of 631 cases (75.7%) involved the upper aerodigestive tract whereas 203 cases (24.3%) were cutaneous. A total of 317 patients (38.0%) had recurrent disease. The NAC group was younger (P < .001) and had less hypertension (P = .011), but had more advanced clinical stage tumors (P < .001) and surgeries with multiple flap reconstruction (P = .007). Patient groups did not differ with regard to wound complications (P = .47), return to operating room (P = .31), or readmission rates (P = .49). The NAC group received more blood transfusions (P < .001) but was found to have a lower risk of overall complications on multivariate analysis (odds ratio, 0.50; 95% CI, 0.30‐0.83). The overall complication rate was unchanged with surgery performed ≤21 days after the last chemotherapy cycle. Conclusions Patients undergoing NAC appear to have a higher disease burden but tend to be younger and healthier. Within the context of this inherent selection bias, NAC does not appear to increase perioperative morbidity among patients undergoing surgery for HNC.

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Section: Discussionmentioning

confidence: 58%

Impact of neoadjuvant chemotherapy on perioperative morbidity after major surgery for head and neck cancer

Kiong

Lin

Yao

et al. 2020

Cancer

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“…These results stand in contrast to previous studies that have shown a significant association between smoking and postoperative pulmonary and neurological complications . In a recent study of patients undergoing laryngectomy, Brady et al also found no increase in overall morbidity attributable to smoking. These authors suggested that the prior literature may have failed to correct for the number of comorbidities associated with smoking, including differences in the extent of disease, which may artificially inflate the risk associated with tobacco smoke.…”

Section: Discussionmentioning

confidence: 99%

Association of Smoking Tobacco With Complications in Head and Neck Microvascular Reconstructive Surgery

Crippen

Patel

Filimonov

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Smoking is a highly prevalent risk factor among patients with head and neck cancer. However, few studies have examined the association of this modifiable risk factor on postoperative outcomes following microvascular reconstruction of the head and neck.OBJECTIVE To analyze the risk associated with smoking in patients undergoing free flap surgery of the head and neck.DESIGN, SETTING, AND PARTICIPANTS In this retrospective, population, database study, the National Quality Improvement Program data sets from 2005 to 2014 were queried for all cases of head and neck surgery involving free flap reconstruction in the United States. The 2193 cases identified were stratified into smoking and nonsmoking cohorts and compared using χ 2 and binary logistic regression analyses. Pack-years of smoking data were used to assess the degree of risk associated with a prolonged history of smoking. All analyses were conducted between January 2018 and June 2018.MAIN OUTCOMES AND MEASURES Smoking and nonsmoking cohorts were compared for rates of demographic characteristics, comorbidities, and complications. Following correction for differences in patient demographics and comorbidities, smoking and nonsmoking cohorts were compared for rates of postoperative complications. Complication rates were further assessed within the smoking cohort by number of pack years smoked. RESULTSOf the 2193 patients identified as having undergone free flap reconstruction of the head and neck, 624 (28.5%) had a history of recent smoking. After accounting for differences in demographic variables and patient comorbidities using regression analyses, smoking status was found to be independently associated with wound disruption (odds ratio, 1.74; 95% CI, 1.17-2.59; P = .006) and unplanned reoperation (odds ratio, 1.50; 95% CI, 1.15-1.95; P = .003). An analysis by pack-years of smoking showed that a longer smoking history was significantly associated with higher rates of numerous comorbidities but not with a corresponding increase in rates of complications.CONCLUSIONS AND RELEVANCE Smokers undergoing free flap reconstruction of the head and neck may be at significantly higher risk of postoperative wound disruption and subsequent reoperation. These risks were independent of pack-years of smoking history, suggesting that both risks were associated with perioperative smoke exposure, and preoperative smoking cessation may be of benefit.LEVEL OF EVIDENCE NA.

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“…Given that smoking status is associated with worse surgical outcomes, head and neck surgeons should have the option to delay operating until smoking cessation is achieved. [4][5][6][7] Continued smoking during adjuvant radiation therapy is further associated with a decreased therapy response and lower rates of survival. 14 Compelling surgeons to operate without taking these risks into account undermines their professional judgment to act in the patient's best interests and can increase their moral distress if they believe that immediate surgery constitutes unnecessarily suboptimal care.…”

Section: Respecting Professional Judgmentmentioning

confidence: 99%

“…4 Smoking is also a risk factor for surgical site infections in patients with head and neck cancer. 5 Brady et al 6 report increased rates of postoperative pneumonia, sepsis, and medical complications in smokers with more than 50 pack-years. In addition, patients who smoke have more frequent flap necrosis, with 83% of paramedian forehead and nasolabial flap failures occurring in this population.…”

Section: Reducing Postoperative Complicationsmentioning

confidence: 99%