The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review

Pai, Kavya; Baaklini, Carla; Cabrera, Claudia I.; Tamaki, Akina; Fowler, Nicole; Maronian, Nicole

doi:10.1002/lary.29905

Cited by 9 publications

(8 citation statements)

References 129 publications

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“…It is more easily acquired and has a similar predictive value compared with the Charlson comorbidity index. The range of resolution in the ECOG scale is very narrow in head and neck cancer patients 30–32 . Transfusion was also associated with a preoperative Hb level below 12.5 g/d ( p < 0.03).…”

Section: Discussionmentioning

confidence: 95%

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Perioperative Blood Transfusion in Head and Neck Cancer Revisited

et al. 2022

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Objective To reevaluate the frequency of perioperative blood transfusion, transfusion triggers, and survival impact in patients with incident, surgically treated head and neck cancer (HNC) in restrictive transfusion regimens. Methods Retrospective analysis of surgically treated patients with incident HNC with and without perioperative blood transfusion between 2008 and 2019 at the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, according to the department's clinical Head and Neck Tumor Registry. Results Of the 590 patients included, perioperative transfusions were administered in 6.3% (n = 37, transfusion group). Following multivariable logistic regression, likelihood of blood transfusions was increased in patients with poorer general health conditions (ASA score III/IV; OR 3.7; 95% CI 1.9–8.6; p = 0.002), hemoglobin <12.5 g/dL (OR 2.7; 95% CI 1.1–6.4; p = 0.03), longer duration of surgery (OR 1.006 per minute of surgery time; 95% CI 1.003–1.008; p < 0.001), and negative p16 status (OR 5.3; 95% CI = 1.1–25; p = 0.03). Based on 14 matching variables related to survival and perioperative blood transfusion, a control group of 37 matching patients without perioperative transfusion was identified. Using univariate analysis, overall survival in transfusion and control groups did not differ significantly (p = 0.25). After adjusting for four parameters with limited matching accuracy (Chi square p < 0.2) in Cox regression analysis, a transfusion related hazard ratio close to 1 (HR 0.92; 95% CI 0.34–2.51; p = 0.87) was observed. Conclusion Considering current restrictive transfusion regimens and general transfusion risks, the administration of blood products in HNC patients during the perioperative period is not associated with additional oncologic hazard. Level of Evidence 3 Laryngoscope, 133:1638–1644, 2023

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Section: Discussionmentioning

confidence: 95%

“…The range of resolution in the ECOG scale is very narrow in head and neck cancer patients. [30][31][32] Transfusion was also associated with a preoperative Hb level below 12.5 g/d (p < 0.03). One approach to avoid preoperative anemia could be to correct iron deficiency.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Blood Transfusion in Head and Neck Cancer Revisited

et al. 2022

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“…19 In a recent systematic review of 116 studies, ASA (60.3%) and CCI (33.6%) were the most commonly used comorbidity indices to evaluate outcomes in patients with head and neck surgery. 20 When evaluating studies that utilized the CCI, the authors found that it reliably predicted 1-year mortality. In this study, we noted that elevated CCI was associated with an increased risk of 90-day and 1-year mortality.…”

Section: Discussionmentioning

confidence: 99%

Postoperative and 1‐Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older

Davis

Kompelli

Gardner

et al. 2022

Otolaryngol.--head neck surg.

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Objective To evaluate the postoperative and 1-year functional outcomes after free flap surgery among patients ≥80 years old. Study Design Retrospective chart review. Setting Single tertiary care center. Methods We conducted a retrospective review of 596 patients who underwent head and neck ablation and reconstruction with free tissue over a 7-year period. Patients ≥80 years of age were included. Results Fifty patients were ≥80 years old, with an average age of 83.7 years. Ninety-day mortality was 12.0%, and those who died were of older age (87.5 vs 83.1 years, P = .036). Prior radiation therapy (odds ratio, 6.8 [95% CI, 1.1-42.7]) and a Charlson Comorbidity Index ≥3 (odds ratio, 10.0 [95% CI, 1.5-67.0]) were associated with an increased risk of 90-day mortality. Overall 21 (42.0%) patients experienced a 30-day complication; 7 (14.0%) were readmitted within 30 days; and 5 (10.0%) underwent additional flap-related operations. Flap failure occurred in 2 (4.0%) patients. Before surgery, 45 (90%) patients were living independently or within assisted living; among these, 19.5% declined to dependent functional status at 90-day follow-up. At 90 days, 2 (8.3%) of 24 patients remained tracheostomy dependent, and 20 (66.7%) of 30 patients required feeding tube supplementation. Among 42 patients, 36 (85.7%) had unrestricted or modified oral diets at 90 days. Charlson Comorbidity Index ≥2 was associated with an increased risk of 1-year mortality (odds ratio, 5.1 [95% CI, 1.4-18.6]). Conclusion The potential for functional decline and risk of 90-day mortality should be discussed with patients aged ≥80 years.

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“…The patient’s global health condition was evaluated according to the ASA score (American Society of Anesthesiologists Physical Status classification system) and according to the ACE-27 score. 19 Both scores are simple to apply even retrospectively: the ASA may be universally applied to surgical patients, while the ACE-27 has been specifically validated for the HN cancer population. 19,20…”

Section: Methodsmentioning

confidence: 99%

“…19 Both scores are simple to apply even retrospectively: the ASA may be universally applied to surgical patients, while the ACE-27 has been specifically validated for the HN cancer population. 19,20…”

Section: Methodsmentioning

confidence: 99%

A 5-year experience with midline catheters in the management of major head and neck surgery patients

et al. 2022

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Background: In the perioperative management of major head and neck surgery (HNS) patients, the performance of midline catheters (MCs) has been never tested. We present here our 5-year experience by reporting MC-related complications and by identifying the preoperative risk factors associated with their development. Methods: Clinical variables were extracted and the dwell time, the number, and the type of postprocedural complications of MCs were retrieved. Complications were classified into major (needing MCs removal and including catheter-related bloodstream infection or deep vein thrombosis or catheter occlusion) and into minor (accidental dislodgement, leaking, etc.). Descriptive statistics and logistic regression models were used in order to identify the predictors of complications. Results: A total of 265 patients were included, with a mean age of 67.4 years. Intraprocedural complications occurred in 1.1% of cases, while postprocedural complications occurred in 13.9% of cases (12.05/1000 days), but they were minor in more than 7.0% (5.4/1000 catheter-days). There were 19 minor complications (7.1% or 5.4/1000 catheter-days) while 18 (7%, 5.1/1000 catheter-days) patients experienced at least one major complication. Female sex (OR = 1.963, 95% CI 1.017–3.792), insertion in the right arm (OR = 2.473, 95% CI 1.150–5.318), and an ACE-27 score >1 (OR = 2.573, 95% CI 1.295–5.110) were independent predictors of major complications. Conclusions: MCs appear to represent an effective option in the setting of major HNS. The identification of patients most at risk for MC-related complications should prompt a postoperative watchful evaluation.

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The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review

Cited by 9 publications

References 129 publications

Perioperative Blood Transfusion in Head and Neck Cancer Revisited

Perioperative Blood Transfusion in Head and Neck Cancer Revisited

Postoperative and 1‐Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older

A 5-year experience with midline catheters in the management of major head and neck surgery patients

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