Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates

Siddiqui, Sana H.; Singh, Roshansa; Siddiqui, Emaad; Zhao, Eric; Eloy, Jean Anderson; Baredes, Soly; Park, Richard Chan Woo

doi:10.1002/lary.27358

Cited by 19 publications

(45 citation statements)

References 25 publications

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“…Herein, we present the largest national study examining the rate of 30‐day readmission after parotidectomy. In our analysis of 15,102 patients, the rate of readmission (3.9%) was greater than the published rates in large database analyses of the National Cancer Database (NCDB) by Zhan et al (2.1%) and the American College of Surgeons’ National Surgical Quality Improvement Program (ACS‐NSQIP) by Siddiqui et al (1.6%) . Both studies, however, likely underestimated the true readmission rate.…”

Section: Discussioncontrasting

confidence: 68%

Understanding nationwide readmissions after parotidectomy

et al. 2019

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Objectives: To evaluate the incidence, causes, risk factors, and costs associated with 30-day readmissions in parotidectomy patients utilizing the Nationwide Readmissions Database (NRD).Study Design: Retrospective cohort study. Methods: We examined the NRD for patients who underwent parotidectomy between 2010 and 2014. Rates, causes, and costs of 30-day readmissions were determined. Multivariate logistic regression was used to identify risk factors for readmission.Results: Among 15,102 included patients, 594 (3.9%) were readmitted within 30 days. The average cost per readmission was $12,502. Infectious (22.7%) and wound (11.2%) complications were the two most common causes of readmission. After controlling for other covariates, significant predictors of readmission included advanced comorbidity (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.09-2.37), a malignant parotid tumor (OR, 2.37; 95% CI, 1.63-3.43), length of stay ≥2 days (OR, 1.54; 95% CI, 1.09-2.18), and nonroutine discharge destinations (home with care [OR, 1.88; 95% CI, 1.27-2.78] and nursing facility [OR, 2.69; 95% CI, 1.55-4.67]).Conclusion: In this nationwide database analysis, we found that nearly 4% of all patients undergoing parotidectomy are readmitted within 30 days. Readmissions are commonly due to infections and wound complications. Quality improvement proposals targeting avoidable readmissions should focus on early recognition and prevention of infection and wound complications. Risk factors contributing to readmission include advanced comorbidity, malignant parotid tumor, prolonged index hospitalization, and nonroutine discharge destinations.

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Section: Discussioncontrasting

confidence: 68%

Understanding nationwide readmissions after parotidectomy

et al. 2019

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“…Two studies reported the specific histopathology of the final surgical specimen, and 2 studies reported only malignancy status. 7,10,14-16…”

Section: Resultsmentioning

confidence: 99%

Outpatient versus Inpatient Parotidectomy: A Systematic Review and Meta‐analysis

Forner

Lee

Walsh

et al. 2020

Otolaryngol.--head neck surg.

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Objective Parotidectomies are commonly performed procedures by head and neck surgeons. Although parotidectomies are historically inpatient procedures, recent observational evidence has highlighted the potential for parotidectomies to be performed on an outpatient basis. This systematic review and meta-analysis sought to compare complications and unplanned health care utilization between patients undergoing outpatient versus inpatient parotidectomy. Data Sources A systematic review was performed using MEDLINE, EMBASE, and the Cochrane Library. Review Methods Studies comparing the outcomes of outpatient parotidectomy with those of inpatient parotidectomy were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Postoperative complications (hematoma, facial nerve dysfunction, seroma, fistulisation, Frey syndrome, and wound infection) and rates of 30-day readmission, reintervention, and emergency department presentation were compared. Results We screened 1018 nonduplicate articles to include 5 studies, all of which were retrospective cohort studies. There were fewer complications found in the outpatient group (relative risk = 0.61, 95% confidence interval: 0.40-0.93). Outpatient procedures were more commonly performed on patients who lived close to the hospital, had fewer comorbidities, and had less extensive planned surgery. Conclusion Outpatient parotidectomy appears safe in select patients with outcomes comparable with inpatient surgery. However, evidence overall is of low quality, and further work is needed to delineate a satisfactory set of criteria for appropriate patient identification.

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“…Previous studies have demonstrated that one of the greatest expenses for surgical patients is length of time in hospital following surgery, which is prolonged in patients with surgical drains [ 14 , 32 , 33 ]. Given these findings, there has been increased interest in performing outpatient head and neck procedures, including parotid surgery [ 34 – 36 ]. A recent systematic review and meta-analysis by Flach et al [ 37 ] demonstrated that outpatient parotidectomy appeared to be safe with no increased risk of postoperative complications or readmission rates compared to inpatient procedures.…”

Section: Discussionmentioning

confidence: 99%

Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction

Melong

Rigby

Corsten

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background Patients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey’s syndrome. Traditionally, surgical drains have been placed at the end of surgery to prevent hematoma and sialocele formation. However, this can increase the risk of postoperative complications and contribute to a prolonged course in hospital. To try and prevent these risks and complications, we introduced a novel technique of a drainless parotidectomy by reconstructing the resulting parotid bed defect with a superiorly based sternocleidomastoid (SCM) rotational flap and by placement of gelfoam into the wound bed and a facelift dressing postoperatively to provide additional hemostasis and avoid drain placement. Methods All patients with benign parotid disease undergoing a drainless superficial parotidectomy and reconstruction with a superiorly based SCM rotational flap at our center were identified within a prospective cohort database between July 2010–2018. Primary outcomes included postoperative cosmetic and functional outcomes, complications and length of hospital stay. A secondary cost analysis was done to compare this novel technique to traditional superficial parotidectomy with surgical drain placement. Results Fifty patients were identified within the database and were included in the final analysis. The average length of hospital stay was 1.02 days. All patients were satisfied with their aesthetic outcome at 1 year. During long term follow-up, 63% of patients reported normal appearance of the operated side. Seven patient’s (14%) developed temporary facial paresis following surgery. All patients had resultant normal facial function at follow-up in 1 year. No patients developed subjective Frey’s Syndrome. Two patients (4%) developed a postoperative sialocele requiring drainage and one patient (2%) developed a hematoma on extubation requiring evacuation and drain placement. Cost analysis demonstrated a cost savings of approximately $975 per person following surgery. Conclusion In the current study, we introduced a novel approach of a drainless superficial parotidectomy using a superiorly based SCM flap, gelfoam and placement of a post-operative facelift dressing. This drainless approach was associated with good long-term cosmetic and functional outcomes with few postoperative complications. This new technique may also offer the potential for long-term savings to the health care system.

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Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates

Cited by 19 publications

References 25 publications

Understanding nationwide readmissions after parotidectomy

Understanding nationwide readmissions after parotidectomy

Outpatient versus Inpatient Parotidectomy: A Systematic Review and Meta‐analysis

Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction

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