Discharge Disposition After Head and Neck Reconstruction: Effect on Adjuvant Therapy and Outcomes

Dang, Sophia; Patel, Terral; Lao, Isabella; Sridharan, Shaum; Solari, Mario G.; Kim, Seungwon; Duvvuri, Umamaheswar; Ferris, Robert L.; Kubik, Mark

doi:10.1002/lary.30648

Cited by 1 publication

(1 citation statement)

References 17 publications

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“…Discharge to a facility as opposed to home discharge is also a risk factor for radiation delay. 18 Given the nature of the literature consisting mostly of single-institution case series of variable population size, it is challenging to make inferences as to the frequency of complications, their types, and risk factors without larger scale analysis. Moreover, the reporting of complications in single institution case series may be imprecise due to both reporting and positivity bias as outcomes may be better at high volume institutions.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Complications in Patients Undergoing Temporal Bone Resection and Neck Dissection: Insights From a National Database

Ordoyne,

Alvarez,

Borne

et al. 2024

Ann Otol Rhinol Laryngol

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Background: Temporal bone resection (TBR) with or without neck dissection (ND) is performed for otologic malignancies with occult or clinical cervical lymph node metastases. To date, characterization of post-operative complications in single institution case series may be non-representative of real-world outcomes. Here, we used data from the National Inpatient Sample (NIS) to comprehensively assess the complications encountered, their frequencies, and to identify underlying risk factors to improve future outcomes. Methods The population was patients undergoing TBR and ND derived from the NIS between the years of 2017 and 2019. We utilized ICD-10 diagnosis codes to identify patients with post-operative complications, those discharged to non-home facilities (DNHF), and those with increased length of stay (LOS). Multivariable regression was performed to identify significant variables related to the above outcomes. Results: Ninety of 277 patients that underwent LTBR with ND had postoperative complications. Wound complications were the most frequent complication, occurring in 11 (4%) of patients, followed by CSF leak (n = 6; 2.2%), with acute respiratory failure being the most common medical complication (n = 4; 1.4%). Sixteen percent (45/277) were discharged to a facility besides home. Dementia (OR = 7.96; CI95 3.62-17.48), anemia (OR = 2.39; CI95 1.15-4.99), congestive heart failure (OR = 5.31; CI95 1.82-15.45), COPD (OR = 3.70; CI95 1.35-10.16), and history of prior stroke (OR = 8.50; CI95 1.55-46.68) increased the odds of DNHF. When evaluating LOS (median = 5 days, IQR = 1, 9), anemia (OR = 5.49; CI95 2.86-10.52), and Medicaid insurance (OR = 3.07; CI95 1.06-10.52) were found to increase the LOS. Conclusions: The vast majority of patients undergoing LTBR with ND have no complications and are discharged within a week. Liver disease is a risk factor for medical complications and increased charges. Patients with dementia or a prior stroke are at risk for DNHF, and those with prior anemia are at risk for a wound complication. Lay Summary: This study identified factors related to worse post-operative outcomes in patients undergoing temporal bone resection and neck dissection. Although safe for most patients, an existing diagnosis of liver disease, stroke, dementia, and anemia specifically are at risk for developing negative outcomes. Level of Evidence: 3.

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Section: Introductionmentioning

confidence: 99%