Predictors of Adverse Events after Total Laryngectomy: An Analysis of the 2005-2012 NSQIP Datasets
Alexei Mlodinow, Nima Khavanin, Courtney Shires, Sandeep Samant, Jon Ver Halen* and John Kim
Abstract:
Background: We reviewed the 2005-2012 ACS-NSQIP database to evaluate factors associated with adverse events after total laryngectomy.
Methods: All total laryngectomies performed from 2006 to 2012 were identified for analysis. The cohort was characterized with respect to preoperative and demographic characteristics, complications, reoperation, and mortality.
Results: 713 cases were identified. Complications of any category occurred in 273 cases (38.3%). Factors that were found to confer significant risk for medical complications were increased age [Odds Ratio (OR) 1.03], prior PCI (OR 2.84), disseminated cancer (OR 2.47), chronic steroid/immunosuppression use (OR 2.87), unintended weight loss > 10% over 6 months prior to surgery (OR 2.02), increasing work RVU total (OR 1.02), and increased anesthesia Z-score (OR 1.31). Only increased anesthesia Z-score (OR 1.27) was found to be a statistically significant risk factor for surgical complications. Chronic steroid/immunosuppression use (OR 3.16) and increased anesthesia Z-score (OR 1.29) were both found to be statistically significant risk factors of reoperation within 30 days.
Conclusions: NSQIP is the only dataset that correctly discerns between minimally invasive and wide excision in laryngectomy. The use of the NSQIP dataset may be imperfect, as pertinent details of chemotherapy and radiation, and procedure-specific complications, including fistula formation, are not tracked. Capture rates of laryngectomy are low, but the granularity of patient data is unrivaled. In spite of this, our findings suggest avenues for improvement in the care of total laryngectomy patients, and suggest directions for a laryngectomy-specific outcomes database.
Alexei Mlodinow, Nima Khavanin, Courtney Shires, Sandeep Samant, Jon Ver Halen* and John Kim
Abstract:
Background: We reviewed the 2005-2012 ACS-NSQIP database to evaluate factors associated with adverse events after total laryngectomy.
Methods: All total laryngectomies performed from 2006 to 2012 were identified for analysis. The cohort was characterized with respect to preoperative and demographic characteristics, complications, reoperation, and mortality.
Results: 713 cases were identified. Complications of any category occurred in 273 cases (38.3%). Factors that were found to confer significant risk for medical complications were increased age [Odds Ratio (OR) 1.03], prior PCI (OR 2.84), disseminated cancer (OR 2.47), chronic steroid/immunosuppression use (OR 2.87), unintended weight loss > 10% over 6 months prior to surgery (OR 2.02), increasing work RVU total (OR 1.02), and increased anesthesia Z-score (OR 1.31). Only increased anesthesia Z-score (OR 1.27) was found to be a statistically significant risk factor for surgical complications. Chronic steroid/immunosuppression use (OR 3.16) and increased anesthesia Z-score (OR 1.29) were both found to be statistically significant risk factors of reoperation within 30 days.
Conclusions: NSQIP is the only dataset that correctly discerns between minimally invasive and wide excision in laryngectomy. The use of the NSQIP dataset may be imperfect, as pertinent details of chemotherapy and radiation, and procedure-specific complications, including fistula formation, are not tracked. Capture rates of laryngectomy are low, but the granularity of patient data is unrivaled. In spite of this, our findings suggest avenues for improvement in the care of total laryngectomy patients, and suggest directions for a laryngectomy-specific outcomes database.
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