Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases

Abstract

BackgroundParotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy.MethodsA retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events.ResultsThere were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation.ConclusionsThere are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.

Rate of Fat Graft Volume Loss After Parotidectomy

“…23 However, drawbacks to this option include poor skin color match to the recipient site, longer operative time, increased scarring, and greater risk of surgical complications such as hematoma, wound dehiscence, and infection. 22,30 With regards to free fat transfer as a reconstructive option, previous studies advocate for the use of abdominal fat in the parotid bed due to similarities in the tissue’s consistency and texture. 14,16 Previous studies have found fat graft transfer to be a feasible and effective reconstruction option because it is not technically complex, does not prolong operative times, and is associated with minimal postoperative complication rates.…”

Parotidectomy and Facial Paralysis, A Retrospective Review at A Tertiary Care Hospital

“…Study of Bovenzi CD et al shows much improved results with 3.7% facial nerve palsy as they performed reconstructive measures of the nerve, like anastomosis, interpositional grafting and nerve transfer to restore functions of the nerve that we did not offer to our patients. 16 For patients with malignant tumors, large in size, hard fixed with deep lobe involvement, facial nerve injury remains more common. Duration of surgical procedure have direct effect on facial nerve functions.…”

Perioperative Complications after Parotidectomy Using a Standardized Grading Scale Classification System

“…In a retrospective review of 11,057 patients who underwent parotidectomy, low rates of 1.7% medical complications and 3.8% surgical complications were reported. Only wound disruptions, surgical site infections and hemorrhage/hematoma were registered as surgical complications [15]. Indeed, little is known about the true prevalence and severity of acute complications occurring during the first days following parotidectomy when long-term complications (6-24 months postoperatively) and sequalae have been extensively studied in the literature [16][17][18].…”

“…Tumor size was not analyzed as predictive factor in the absence of unambiguous data in the recent literature. In a large retrospective review of 11,057 patients who underwent parotidectomy, tumor size was not reported as predictive of postoperative complications [15]. The correlation between drainage treatment and the incidence of postoperative complication was analyzed in patients undergoing superficial parotidectomy.…”