Understanding Risk Factors Associated With Unplanned Reoperation in Major Head and Neck Surgery

Abstract

IMPORTANCE Understanding the preoperative, intraoperative, and postoperative risk factors of reoperation is the optimal way to approach decreasing its incidence. OBJECTIVE To identify risk factors of unplanned reoperation following major operations of the head and neck. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study queried the American College of Surgeons National Surgical Quality Improvement Program database and identified 2475 cases of major operations of the head and neck performed between 2005 and 2014. Specific operations analyzed were glossectomy, mandibulectomy, laryngectomy, and pharyngectomy. Univariate and multivariate analyses were performed to compare demographic and clinical characteristics of patients with or without unplanned reoperation. Data were analyzed between September and November 2017. MAIN OUTCOMES AND MEASURES The primary outcome was incidence of unplanned reoperation in patients with major operations in the head and neck region. An additional aim was to assess the risk factors associated with an increased likelihood of reoperation. RESULTS In total, 1941 patients were included in this study (1298 [66.9%] males), with most patients (961 [49.5%]) between 61 and 80 years of age. The overall unplanned reoperation rate within 30 days after the principal operative procedure was 14.2% (275 patients). The operative procedure with the highest reoperation rate was pharyngectomy (8 of 46 [17.4%]), followed by glossectomy (95 of 632 [15.0%]), laryngectomy (53 of 399 [13.3%]), and mandibulectomy (25 of 240 [10.4%]). Among the unplanned reoperation patients, 516 patients (76.8%) underwent reoperation during their initial hospital admission and 156 patients (23.2%) after readmission. The mean (SD) number of days from the principal operative procedure to unplanned reoperation was 8.5 (3.6) days for initial-admission reoperations and 16.0 (4.8) days for readmission reoperations. The most common unplanned reoperation procedures overall included repair, surgical exploration, and revision procedures on arteries and veins (47 of 2475 [1.9%]), incision procedures on the soft tissue of the neck and thorax (37 of 1941 [1.9%]), and incision and drainage procedures on the skin, subcutaneous, and accessory structures (21 of 1941 [1.1%]). Multivariate analysis results indicated that the independent risk factors for unplanned reoperation following a major cancer operation of the head or neck included black race (odds ratio [OR], 1.72; 95% CI, 1.09-2.74), disseminated cancer (OR, 1.85; 95% CI, 1.14-3.00), greater total operation time (OR, 2.05; 95% CI, 1.49-2.82), superficial (OR, 2.56; 95% CI, 1.55-4.24) or deep (OR, 4.83; 95% CI, 2.60-8.95) surgical site infection, wound dehiscence (OR, 8.36; 95% CI, 5.10-13.69), and ventilator dependence up to 48 hours after surgery (OR, 2.95; 95% CI, 1.79-4.87). CONCLUSIONS AND RELEVANCE The identification of a significant association of black race, disseminated cancer, total operation time, surgical site infection in either the superficial or deep spaces, wou...

Analysis of risk factors for unplanned reoperation following primary repair of gastrointestinal disorders in neonates

“…In univariate analysis, anoplasty (OR 0.13; p = 0.04), enterectomy (OR 5.11; p < 0.01), duration of intraoperative hypothermia (OR 1.01; p = 0.01), and the length of operative time (OR 1.01; p < 0.01) were significantly associated with unplanned reoperation. However, our multivariate regression analyses identified that the only factor associated with unplanned reoperation was prolonged operative time, which was consistent with previous research [ 16 ]. In plastic surgery, an association between increasing operative time and incidence of unplanned reoperation had been confirmed [ 10 ].…”

“…In plastic surgery, an association between increasing operative time and incidence of unplanned reoperation had been confirmed [ 10 ]. And Sangal et al had revealed that a greater total operation time was associated with an unplanned reoperation in major operations of the head and neck [ 16 ]. These results could be interpreted as a more complex surgical procedure would be more likely to require unplanned reoperation.…”

“…Additionally, a meta-analysis that included 48 studies had presented that most neonates with surgical site infection had gastrointestinal and/or colorectal surgery [ 19 ]. Surgical site infection was associated with increased risk of unplanned reoperation in major head and neck surgery [ 16 ]. Thus, we speculated that gastrointestinal surgery was associated with a high risk of unplanned secondary surgery.…”

Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival

“…To date, there have been many studies investigating short‐term morbidity and mortality associated with head and neck cancer surgeries, including TL. Such studies have investigated factors associated with need for reoperation, 11,12 30‐day unplanned readmission, 13‐18 30‐day mortality, 19 and prolonged inpatient LOS. Those investigating LOS include reviews of institutional 20 and national database 16,19,21 .…”

Assessment of the Clinical Usefulness of Preoperative Computed Tomography in Colorectal Cancer Patients Who Received Unplanned Reoperation

“…Unplanned reoperation was defined by the US NSQIP database as an “unplanned return to the operating room for a surgical procedure related to either the index or concurrent procedure performed” [ 4 ]. Earlier studies have found that colorectal operations account for the greatest proportion of unplanned reoperations.…”