Individualized Risk Estimation for Postoperative Complications After Surgery for Oral Cavity Cancer

Abstract

IMPORTANCE Postoperative complications after head and neck surgery carry the potential for significant morbidity. Estimating the risk of complications in an individual patient is challenging. OBJECTIVE To develop a statistical tool capable of predicting an individual patient’s risk of developing a major complication after surgery for oral cavity squamous cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series derived from an institutional clinical oncologic database, augmented by medical record abstraction, at an academic tertiary care cancer center. Participants were 506 previously untreated adult patients with biopsy-proven oral cavity squamous cell carcinoma who underwent surgery between January 1, 2007, and December 31, 2012. MAIN OUTCOMES AND MEASURES The primary end point was a major postoperative complication requiring invasive intervention (Clavien-Dindo classification grades III–V). Patients treated between January 1, 2007, and December 31, 2008 (354 of 506 [70.0%]) comprised the modeling cohort and were used to develop a nomogram to predict the risk of developing the primary end point. Univariable analysis and correlation analysis were used to prescreen 36 potential predictors for incorporation in the subsequent multivariable logistic regression analysis. The variables with the highest predictive value were identified with the step-down model reduction method and included in the nomogram. Patients treated between January 1, 2007, and December 31, 2008 (152 of 506 [30.0%]) were used to validate the nomogram. RESULTS Clinical characteristics were similar between the 2 cohorts for most comparisons. Thirty-six patients in the modeling cohort (10.2%) and 16 patients in the validation cohort (10.5%) developed a major postoperative complication. The 6 preoperative variables with the highest individual predictive value were incorporated within the nomogram, including body mass index, comorbidity status, preoperative white blood cell count, preoperative hematocrit, planned neck dissection, and planned tracheotomy. The nomogram predicted a major complication with a validated concordance index of 0.79. Inclusion of surgical operative variables in the nomogram maintained predictive accuracy (concordance index, 0.77). CONCLUSIONS AND RELEVANCE A statistical tool was developed that accurately estimates an individual patient’s risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.

Complications following transoral robotic surgery (TORS): A detailed institutional review of complications

“…The process of identification and recording of complications was as described by previous work at our institution(11, 12). All events that occurred in the patient’s record within 45 days of surgery, either in medical, nursing, anesthetic or allied health professional documentation was compared to the definition of a post-operative complication.…”

Nomograms predicting long-term overall survival and cancer-specific survival in head and neck squamous cell carcinoma patients

“…However, HNSCC patient stage, from I to IV, is only based on TNM stage. Consideration of other clinicopathologic factors like age, sex, tumor site and treatment, which are associated with HNSCC patient survival [10–13], is necessary for accurate prognostic analyses. Therefore, our prognosis predictions included age, sex, race, tumor site, surgery and radiotherapy, along with TNM stage.…”

Risk factors for postoperative hemorrhage in patients with oral squamous cell carcinoma: A retrospective study

“…Most previous studies consisted of males who suffered from a higher incidence of postoperative complications, such as systemic disease, flap complications, infection, and hemorrhage . However, Loupatatzi concluded that female patients have a higher risk of developing complications than males in free flap reconstruction due to a higher rate of systemic diseases in females in his study.…”

“…Additional studies should be conducted to identify potential underlying mechanisms that explain differences in sex, such as cigarette and alcohol use. Patel, Bhattacharyya, and Awad found that postoperative complications are related to older age and that the incidence rate increases with age. However, Wu and Thomas found that aging is not a risk factor.…”