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

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Study Design</jats:title><jats:p> Cross-sectional analysis of US national database. </jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p> American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2005 to 2017. </jats:p></jats:sec><jats:sec><jats:title>Subjects and Methods</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> 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. </jats:p></jats:sec>

The impact of time between surgery and adjuvant chemoradiotherapy in advanced oral cavity squamous cell carcinoma

“…Due to the relatively small sample size as compared to larger database studies, the results must be interpreted with caution. However, larger databases and big data studies have an increased risk of selection bias by assigning patients into two study groups without necessarily stratifying for confounders ( 26 , 27 ). The aim was therefore to reduce confounding bias by focusing on advanced OSCC and POCRT as the sole AT regime, as well as by considering group equality regarding histopathological risk markers.…”

Age, ASA‐status, and Changes in NSQIP Comorbidity Indices Reporting in Facial Fracture Repair

“…Given the lack of uniformity in the reporting of comorbidity variables and the subsequent difficulty with data analysis and drawing conclusions with incomplete data, we eliminated the mFI and mCCI evaluations in this study. Overall, when working with the NSQIP database and other administrative databases, it is important that researchers report any missing data and the details of data collection, as this has large implications on statistical analysis 18 …”

“…Overall, when working with the NSQIP database and other administrative databases, it is important that researchers report any missing data and the details of data collection, as this has large implications on statistical analysis. 18…”

The Opportunity Cost of Resident Involvement in Adult Craniofacial Surgery: An Analysis of Relative Value Units

“…16 The ACS-NSQIP is a nationally recognized, validated, risk-adjusted, and 19,20 ; and head and neck reconstruction (15756,15757,15758,20969,20955,20956,20962,20970). 21 Only patients who had International Classification of Diseases codes or additional Current Procedural Terminology (CPT) codes indicating the surgical location being of the head and neck were included (ie, patients with an International Classification of Diseases diagnostic code of 173.4: ''Malignant neoplasm of the scalp and skin of neck'').…”

“…The ACS-NSQIP is a nationally recognized, validated, risk-adjusted, and outcomes-based tool for a variety of surgical procedures. Patients were first identified using Current Procedural Terminology codes: facial reanimation (64716, 64864, 64868, 64885, 64886, 64910, 64727, 15840, 15841, 15842, 15845, 67917, 67912, 67900) 17 ; facial trauma (21343, 21344, 21346, 21347, 21348, 21355, 21356, 21360, 21365, 21366, 21385, 21386, 21387, 21390, 21395, 21406, 21407, 21408, 21422, 21423, 21432, 21433, 21435, 21436, 21445, 21454, 21461, 21462, 21465, 21470) 18 ; orthognathic surgery (21141, 21142, 21143, 21145, 21146, 21147, 21150, 21154, 21155, 21159, 21193, 21194, 21195, 21196, 21198, 21199, 21206) 19,20 ; and head and neck reconstruction (15756, 15757, 15758, 20969, 20955, 20956, 20962, 20970) 21 . Only patients who had International Classification of Diseases codes or additional Current Procedural Terminology (CPT) codes indicating the surgical location being of the head and neck were included (ie, patients with an International Classification of Diseases diagnostic code of 173.4: “Malignant neoplasm of the scalp and skin of neck”).…”