Postoperative Complications Associated With Choice of Reconstruction in Head and Neck Cancer: An Outcome Analysis From the American College of Surgeons-National Surgical Quality Improvement Database Article Swipe
Jacob Katsnelson
,
Richard Tyrell
,
Ely Manstein
,
Murad J. Karadsheh
,
Brian L. Egleston
,
Mengying Deng
,
Sameer A. Patel
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1097/01.gox.0000720432.12157.b8
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1097/01.gox.0000720432.12157.b8
BACKGROUND: Microsurgical free flaps have supplanted myocutaneous pedicled flaps as the gold standard for head and neck cancer reconstruction in terms of lending a superior functional and aesthetic result.1–4 However, factors relating to postoperative complications based on type of reconstruction have not been well-defined in the literature. In this study, we used the American College of Surgeons-National Surgical Quality Improvement database to compare outcomes of patients who underwent free flap, myocutaneous pedicled flap, or no reconstruction after resection for head and neck cancer. METHODS: Patients undergoing head and neck reconstruction were identified in the 2011–2016 American College of Surgeons-National Surgical Quality Improvement database using ICD codes for head and neck cancers and current procedural terminology codes to filter by reconstructive technique used. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting between groups. Logistic regression was used for binary outcomes, and Gamma GLM was used for length of stay. Outcomes were defined based on major surgical complications, wound complications, and medical complications within 30 days postoperatively. RESULTS: Four thousand seven hundred twelve patients met inclusion criteria: 1,297 patients (28%) underwent reconstruction with free flap, 208 patients (4%) with myocutaneous pedicled flap, and 3,207 patients (68%) had no reconstruction. In unadjusted analyses, patients who underwent pedicled flap reconstruction had a higher incidence of surgical site infection, wound dehiscence, pneumonia, and hospital readmission compared with free flap reconstruction or no reconstruction (P < 0.001). After adjustment, pedicled flap reconstruction was found to have a higher risk of developing DVT (OR, 2.64; CI, 1.02–6.85; P = 0.045), sepsis (OR, 2.95; CI, 1.52–5.71; P = 0.001), and infection (OR, 2.03; CI, 1.39–2.96; P < 0.001) compared with free flap reconstruction. However, pedicle flap reconstruction had a shorter mean operative time (unadjusted 440 versus 574 minutes; P < 0.001), lower incidence of bleeding requiring transfusion (adjusted OR, 0.65; CI, 0.50–0.85; P = 0.002), and lower incidence of prolonged mechanical ventilation after 48 hours (adjusted OR, 0.33; CI, 0.12–0.92; P = 0.04) compared with free flap reconstruction. CONCLUSION: Myocutaneous pedicled flaps are associated with an overall higher short-term postoperative complication rate compared to free flaps in reconstruction for head and neck cancer, despite having a shorter operative time and lower requirement for transfusion and prolonged intubation. These differences in postoperative complications could reflect selection bias, as patients likely to undergo pedicled flap reconstruction in today’s era may not be candidates for free flap reconstruction, be undergoing salvage procedures, or be at centers without the ability to perform free tissue transfer. However, this study once again confirms the superiority of free flaps in head and neck reconstruction. REFERENCES 1. Patel SA, Chang EI. Principles and practice of reconstructive surgery for head and neck cancer. Surg Oncol Clin N Am. 2015;24:473–489. 2. Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck. 2010;32:1236–1245. 3. Gurtner GC, Evans GR. Advances in head and neck reconstruction. Plast Reconstr Surg. 2000;106:672–682; quiz 683. 4. Hurvitz KA, Kobayashi M, Evans GR. Current options in head and neck reconstruction. Plast Reconstr Surg. 2006;118:122e–133e.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1097/01.gox.0000720432.12157.b8
- OA Status
- gold
- Cited By
- 1
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3160135174
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3160135174Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1097/01.gox.0000720432.12157.b8Digital Object Identifier
- Title
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Postoperative Complications Associated With Choice of Reconstruction in Head and Neck Cancer: An Outcome Analysis From the American College of Surgeons-National Surgical Quality Improvement DatabaseWork title
- Type
-
articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2020Year of publication
- Publication date
-
2020-09-01Full publication date if available
- Authors
-
Jacob Katsnelson, Richard Tyrell, Ely Manstein, Murad J. Karadsheh, Brian L. Egleston, Mengying Deng, Sameer A. PatelList of authors in order
- Landing page
-
https://doi.org/10.1097/01.gox.0000720432.12157.b8Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
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https://doi.org/10.1097/01.gox.0000720432.12157.b8Direct OA link when available
- Concepts
-
Medicine, Surgery, Current Procedural Terminology, Wound dehiscence, Breast reconstruction, Free flap, Quality of life (healthcare), Head and neck cancer, Incidence (geometry), Database, Cancer, Breast cancer, Radiation therapy, Internal medicine, Optics, Nursing, Physics, Computer scienceTop concepts (fields/topics) attached by OpenAlex
- Cited by
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1Total citation count in OpenAlex
- Citations by year (recent)
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2024: 1Per-year citation counts (last 5 years)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.prolonged | 314, 370 |
| abstract_inverted_index.requiring | 300 |
| abstract_inverted_index.resection | 77 |
| abstract_inverted_index.selection | 379 |
| abstract_inverted_index.technique | 120 |
| abstract_inverted_index.today’s | 390 |
| abstract_inverted_index.transfer. | 415 |
| abstract_inverted_index.underwent | 67, 181, 205 |
| abstract_inverted_index.weighting | 132 |
| abstract_inverted_index.Principles | 438 |
| abstract_inverted_index.REFERENCES | 432 |
| abstract_inverted_index.associated | 338 |
| abstract_inverted_index.candidates | 395 |
| abstract_inverted_index.covariates | 126 |
| abstract_inverted_index.developing | 247 |
| abstract_inverted_index.functional | 25 |
| abstract_inverted_index.identified | 91 |
| abstract_inverted_index.infection, | 216 |
| abstract_inverted_index.mechanical | 315 |
| abstract_inverted_index.pneumonia, | 219 |
| abstract_inverted_index.procedural | 113 |
| abstract_inverted_index.propensity | 130 |
| abstract_inverted_index.regression | 136 |
| abstract_inverted_index.short-term | 343 |
| abstract_inverted_index.supplanted | 5 |
| abstract_inverted_index.unadjusted | 201 |
| abstract_inverted_index.undergoing | 85, 401 |
| abstract_inverted_index.(unadjusted | 288 |
| abstract_inverted_index.2011–2016 | 94 |
| abstract_inverted_index.BACKGROUND: | 0 |
| abstract_inverted_index.CONCLUSION: | 333 |
| abstract_inverted_index.Improvement | 59, 101 |
| abstract_inverted_index.adjustment, | 235 |
| abstract_inverted_index.dehiscence, | 218 |
| abstract_inverted_index.differences | 373 |
| abstract_inverted_index.intubation. | 371 |
| abstract_inverted_index.literature. | 46 |
| abstract_inverted_index.procedures, | 403 |
| abstract_inverted_index.readmission | 222 |
| abstract_inverted_index.requirement | 366 |
| abstract_inverted_index.score-based | 131 |
| abstract_inverted_index.superiority | 423 |
| abstract_inverted_index.terminology | 114 |
| abstract_inverted_index.transfusion | 301, 368 |
| abstract_inverted_index.ventilation | 316 |
| abstract_inverted_index.0.12–0.92; | 324 |
| abstract_inverted_index.0.50–0.85; | 306 |
| abstract_inverted_index.1.02–6.85; | 252 |
| abstract_inverted_index.1.39–2.96; | 269 |
| abstract_inverted_index.1.52–5.71; | 260 |
| abstract_inverted_index.Demographics | 122 |
| abstract_inverted_index.Myocutaneous | 334 |
| abstract_inverted_index.complication | 345 |
| abstract_inverted_index.myocutaneous | 6, 70, 190 |
| abstract_inverted_index.result.1–4 | 28 |
| abstract_inverted_index.well-defined | 43 |
| abstract_inverted_index.Microsurgical | 1, 460 |
| abstract_inverted_index.complications | 34, 163, 376 |
| abstract_inverted_index.postoperative | 33, 344, 375 |
| abstract_inverted_index.complications, | 158, 160 |
| abstract_inverted_index.reconstruction | 18, 39, 75, 89, 182, 208, 227, 230, 238, 281, 352, 388 |
| abstract_inverted_index.reconstructive | 119, 442 |
| abstract_inverted_index.reconstruction, | 399 |
| abstract_inverted_index.reconstruction. | 199, 277, 332, 431, 467, 481, 501 |
| abstract_inverted_index.postoperatively. | 167 |
| abstract_inverted_index.Surgeons-National | 56, 98 |
| abstract_inverted_index.2015;24:473–489. | 454 |
| abstract_inverted_index.2000;106:672–682; | 485 |
| abstract_inverted_index.2010;32:1236–1245. | 470 |
| abstract_inverted_index.2006;118:122e–133e. | 505 |
| cited_by_percentile_year.max | 94 |
| cited_by_percentile_year.min | 90 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 7 |
| citation_normalized_percentile.value | 0.31364665 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |