Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006–2011 National Surgical Quality Improvement Program (NSQIP) Database

Abstract

While neck dissection is an important primary and adjunctive procedure in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed to identify factors associated with adverse events (AEs) in patients undergoing neck dissection. A total of 619 patients were identified, using CPT codes specific to neck dissection. Of the 619 patients undergoing neck dissection, 142 (22.9%) experienced an AE within 30 days of the surgical procedure. Risk factors on multivariate regression analysis associated with increased AEs included dyspnea (odds ratio [OR] 2.57; 95% confidence interval [CI] 1.06 to 6.22; p = 0.037), previous cardiac surgery (OR 3.38; 95% CI 1.08 to 10.52; p = 0.036), increasing anesthesia time (OR 1.005; 95% CI 1 to 1.009; p = 0.036), and increasing total work relative value units (OR 1.09; CI 1.04 to 1.13; p < 0.001). The current study is the largest, most robust analysis to identify specific risk factors associated with AEs after neck dissection. This information will assist with preoperative optimization, patient counseling, and appropriate risk stratification, and it can serve as benchmarking for institutions comparing surgical outcomes.

Evaluation of Older Age and Frailty as Factors Associated With Depression and Postoperative Decision Regret in Patients Undergoing Major Head and Neck Surgery

“…Our study group accurately represents the complexity of the HNC surgical population with a broad range of primary tumor sites and most patients requiring microvascular reconstruction (77.4%). The rate of surgical complications (114 [41.6%]) is within rates of postoperative complications reported in the literature …”

“…The rate of surgical complications (114 [41.6%]) is within rates of postoperative complications reported in the literature. [33][34][35] The reported rates of depression in the literature in patients with HNC vary significantly. Our study revealed a preoperative rate of moderate to severe depression of 9.6%, which is at the lower end of previously reported rates, with no difference between age groups.…”