Comments on “Head and Neck Reconstruction: Does Surgical Specialty Affect Complication Rates?”

Drinane, James J.; Patel, Ashit

doi:10.1055/s-0039-3400272

J Reconstr Microsurg

2019

DOI: 10.1055/s-0039-3400272

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Comments on “Head and Neck Reconstruction: Does Surgical Specialty Affect Complication Rates?”

James J. Drinane

Ashit Patel

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2020

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Cited by 2 publications

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“…Specifically, the method of excluding free tissue transfer outside of the head and neck was not described. In a response to our concerns, Drinane explained that head and neck cancer cases were identified using International Classification of Diseases (ICD) codes 8 . However, the list of codes used for this purpose was not provided.…”

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confidence: 99%

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National Database Research in Head and Neck Reconstructive Surgery: A Call for Increased Transparency and Reproducibility

Bur

Villwock

Nallani

et al. 2020

Otolaryngol.--head neck surg.

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Objective To reproduce a published study comparing outcomes of patients who underwent microvascular reconstruction by plastic surgeons and otolaryngologists and to examine how case selection and methodology using the National Surgical Quality Improvement Program (NSQIP) data set can affect results and conclusions. Study Design Cross-sectional analysis of US national database. Setting American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2005 to 2017. Subjects and Methods A recently published study that used the NSQIP database to compare outcomes after head and neck free tissue transfer between plastic surgeons and otolaryngologists was reproduced. Different approaches to case selection and statistical analysis were evaluated and their effects on statistical significance and study conclusions were compared. Results When all cases of free tissue transfer, captured in NSQIP between 2005 and 2017, were compared between plastic surgery and otolaryngology, plastic surgery patients appeared to have lower rates of complications and length of stay. However, a more in-depth analysis demonstrated that these results were confounded by older and sicker otolaryngology patients. A second analysis of the same NSQIP data, limited to only head and neck oncologic reconstructions, demonstrated that otolaryngology patients had fewer complications on univariate and multivariable analysis. Conclusion We demonstrated how case selection and analysis can significantly affect results. It is incumbent upon researchers who use NSQIP and other publicly available data sets to fully detail their methodology to allow other researchers to reproduce and evaluate their work and for the journal editorial process to carefully evaluate the methodology and conclusions of their contributing authors.

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mentioning

confidence: 99%

“…In a response to our concerns, Drinane explained that head and neck cancer cases were identified using International Classification of Diseases (ICD) codes. 8 However, the list of codes used for this purpose was not provided.…”

mentioning

confidence: 99%

National Database Research in Head and Neck Reconstructive Surgery: A Call for Increased Transparency and Reproducibility

Bur

Villwock

Nallani

et al. 2020

Otolaryngol.--head neck surg.

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Do Microsurgical Outcomes Differ Based on Which Specialty Does the Operation? A NSQIP Analysis

Zhang

Wan

Ding

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Because plastic surgeons do not “own” a specific anatomic region, other surgical specialties have increasingly assumed procedures historically performed by plastic surgery. Decreased case volume is postulated to be associated with higher complication rates. Herein, we investigate whether volume and surgical specialty have an impact on microsurgical complications, specifically surgical site infection (SSI) and reoperation rates. Methods: The 2005–2015 National Surgical Quality Improvement Program participant use file was queried by Current Procedural Terminology code for breast and head/neck microsurgeries. Multivariate logistic regression was performed to compare the outcomes between surgical specialties. A cumulative frequency variable was introduced to investigate the effect of case volume on complication rates. Results: We captured 6,617 microsurgical cases. Multivariate logistic regression revealed that although the rate of SSI was lower in plastic surgery compared with otolaryngology for head and neck reconstructions (13.3% versus 10.5%) and compared with general surgery for breast reconstructions (5.4% versus 4.7%), there was no significant difference between specialties (P = 0.13; P = 0.96). Increased case volume is negatively correlated with complications. Conclusions: Plastic surgery is at risk given case cannibalization by other specialties. We conclude that surgical specialty does not affect the rates of SSI and reoperation. We demonstrate a correlation between lower volumes and increased complications, implying that, once a specialty has amassed critical case experience, complication rates may decrease, and outcomes can be equivalent or superior. Case breadth and volumes should be maintained to preserve skills, optimize outcomes, and maintain the specialty as it currently exists.

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Comments on “Head and Neck Reconstruction: Does Surgical Specialty Affect Complication Rates?”

Cited by 2 publications

References 5 publications

National Database Research in Head and Neck Reconstructive Surgery: A Call for Increased Transparency and Reproducibility

National Database Research in Head and Neck Reconstructive Surgery: A Call for Increased Transparency and Reproducibility

Do Microsurgical Outcomes Differ Based on Which Specialty Does the Operation? A NSQIP Analysis

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