Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery

Shepherd, Sally; Creber, Nathan; Mansour, Kristy; Wiesenfeld, D.; Iseli, Tim A.; Amott, Deborah

doi:10.1111/ans.15611

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…13,14 Our findings suggest that these factors can increase intraoperative technical difficulties and prolong operative times, thus resulting in a higher rate of intraoperative complications, such as bleeding, tracheostomy tube displacement, and respiratory arrest. Previous studies have reported that increasing comorbidity resulted in higher rates of postoperative infection, cardiac events, respiratory failure, and mortality in the late postoperative stage, 15,16 which was also established in our study. According to univariable analysis, the number of comorbidities was a significant risk factor for late postoperative complications and the occurrence of all complications, with pneumonia being the most frequent.…”

Section: Discussionsupporting

confidence: 88%

Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

Jotić

Milovanović

Trivić

et al. 2020

Otolaryngol.--head neck surg.

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Objective In emergency airway management, the occurrence of surgical tracheotomy complications is increased and may be fatal for the patient. However, the factors that play a role in complication occurrence and lead to lethal outcome are not known. The objective of this study was to determine predictors associated with the occurrence of complications and mortality after emergency surgical tracheostomy. Study Design Retrospective study with a systematic review of the literature. Setting Tertiary medical academic center. Subjects and Methods We included 402 adult patients who underwent emergency surgical tracheostomy under local anesthesia due to upper airway obstruction. Demographic, clinical, complication occurrence, and mortality data were collected. For statistical analysis, univariable and multivariable logistic regression methods were used. Results In multivariable analysis, significant positive predictors of complication occurrence were previously performed tracheotomy (odds ratio [OR] 3.67, 95% confidence interval [CI], 0.75–17.88), neck pathology (OR 2.05, 95% CI 1.1–1.77), and tracheotomy performed outside the operating room (OR 5.88, 95% CI, 1.58–20). General in-hospital mortality was 4%, but lethal outcome as a direct result of tracheotomy complications occurred in only 4 patients (1%) because of intraoperative and postoperative complications. Conclusion The existence of neck pathology and situations in which tracheotomy was performed outside the operating room in uncontrolled conditions were significant prognostic factors for complication occurrence. Tracheotomy-related mortality was greater in patients with intraoperative and early postoperative complications. Clinicians should be aware of the increased risk in specific cases, to prepare, prevent, or manage unwanted outcomes in further treatment and care.

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Section: Discussionsupporting

confidence: 88%

Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

Jotić

Milovanović

Trivić

et al. 2020

Otolaryngol.--head neck surg.

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“… 2 , 24 , 36 , 51 Male patients are more likely to experience postoperative complications that are associated with PORT delay and demonstrate worse overall survival compared to female patients. 52 Although there is not enough evidence to declare a relationship between gender/sex and delayed PORT, Mazul et al found that although female patients with HNSCC had greater overall survival than males, Black female patients had significantly worse survival rates than White and Hispanic male patients. 53 This interaction would be interesting to study in rates of delayed PORT.…”

Section: Resultsmentioning

confidence: 99%

An equity‐based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma

Noyes

Burks

Larson

et al. 2021

Laryngoscope Investig Oto

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Objectives: The majority of patients with head and neck squamous cell carcinoma (HNSCC) do not commence postoperative radiation treatment (PORT) within the recommended 6 weeks. We explore how delayed PORT affects survival outcomes, what factors are associated with delayed PORT initiation, and what interventions exist to reduce delays in PORT initiation. Methods: We conducted a PubMed search to identify articles discussing timely PORT for HNSCC. We performed a narrative review to assess survival outcomes of delayed PORT as well as social determinants of health (SDOH) and clinical factors associated with delayed PORT, using the PROGRESS-Plus health equity framework to guide our analysis. We reviewed interventions designed to reduce delays in PORT. Results: Delayed PORT is associated with reduced overall survival. Delays in PORT disproportionately burden patients of racial/ethnic minority backgrounds, Medicaid or no insurance, low socioeconomic status, limited access to care, more comorbidities, presentation at advanced stages, and those who experience postoperative complications. Delays in PORT initiation tend to occur during transitions in head and neck cancer care. Delays in PORT may be reduced by interventions that identify patients who are most likely to experience delayed PORT, support patients according to their specific needs and barriers to care, and streamline care and referral processes. Conclusions: Both SDOH and clinical factors are associated with delays in timely PORT. Structural change is needed to reduce health disparities and promote equitable access to care for all. When planning care, providers must consider not only biological factors but also SDOH to maximize care outcomes.

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“…Besides comorbidities, we know that age can affect surgical decision making in older adults. In a study of head and neck cancers, Stepherd et al (14) found that age alone had no effect on postoperative mortality, complications, and length of hospital stay. Cost is also considered in deciding on surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the evaluation of hemogram parameters, this study examined the older adults according to whether they were approved for surgery or considered inoperable. In the literature, mortality analyses were mostly performed in studies on gastric or tumor surgery, and surgical decision differs according to the stages of the disease or diagnosis (14,15). However, acute abdominal pathologies may not always require surgery.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the relationship of hemogram parameters with prognosis in older adults with acute abdominal pathologies

Akça¹,

Algın²,

Özdemir³

et al. 2022

Journal of Health Sciences and Medicine

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Aim:We aimed to investigate the effects of hemogram parameters on the short-term mortality of older adults with acute abdominal pathologies. Secondly, it was aimed to investigate the effect of hemogram parameters on mortality in operated and non-operated patients. Material and Method: This retrospective observational study was conducted in an emergency medicine clinic between June 1, 2019, and June 1, 2020. Data on patients over 65 years of age who presented to the emergency department with acute abdominal pathologies were analyzed. Hemogram parameters, as in our patient group over 65 years old, who presented with all acute abdomen pathologies; It was examined in terms of its relationship with prognosis in our operated and non-operated patient group. Statistical analysis was performed using SPSS v. 26.0. Results:The study included a total of 744 patients, of whom 391(52.6%) were women. Mortality was seen in 114(15.32%) patients, and 83(11.2%) patients underwent surgery. AUC and cut off values are for leukocytes count 0.590 and 10.83 for neutrophils count 0.596 and 9.64 for neutrophil-lymphocyte ratio 0.606 and 8.24 to predict mortality (p=0.002, p=0.001, and p>0.001, respectively Conclusion: In this study, among the hemogram parameters; leukocytes, neutrophils and neutrophil-lymphocyte ratio were determined to have a statistically significant ability to predict mortality in older adults both operaple and non operabl groups groups presenting with acute abdominal pathologies, but their accuracy rates were low.

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Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery

Cited by 8 publications

References 17 publications

Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

An equity‐based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma

Evaluation of the relationship of hemogram parameters with prognosis in older adults with acute abdominal pathologies

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