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Xie M, Staibano P, Gupta MK, Nguyen NT, Archibald SD, Jackson BS, Young JEM, Zhang H. Socioeconomic Status, Length of Stay, and Postoperative Complications in Oral Cavity Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2024:1455613241253146. [PMID: 38840527 DOI: 10.1177/01455613241253146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background: Despite universal healthcare in Canada, low socioeconomic status (SES) has been associated with worse survival in oral cavity squamous cell carcinoma (OCSCC) patients. However, the relationship between SES and outcomes during the acute postoperative period is poorly defined. Hamilton, Ontario, presents a unique population with widely varying SES within the same geography. The objective of this study was to examine the relationship between SES, length of hospital stay (LOHS), and postoperative complications in OCSCC. Methods: Newly diagnosed OCSCC patients receiving primary surgical treatment from 2010 to 2014 were identified within a prospectively collected database. Inclusion criteria included age >18 years old, pathological diagnosis of oral cavity cancer, and primary surgical treatment with curative intent. Patients were excluded if they were undergoing palliative treatment or had previous head and neck surgery/radiotherapy. Postal codes were used to identify neighborhood-level socioeconomic variables via 2011 Canada Census data. Income quartiles were defined from groups of neighboring municipalities based on Canada Census definitions. Demographic, social, pathological, staging, and treatment data were collected through chart review. Results: One hundred and seventy-four patients were included in the final analysis. OCSCC patients with lower SES were more likely to be younger (P = .041), male (P = .040), have significant tobacco and alcohol use (P = .001), higher Charlson Comorbidity Index (CCI; P = .014), lower levels of education (P = .001), and have lower employment levels (P = .001). Lower SES patients had higher clinical tumor (P = .006) and clinical nodal (P = .004) staging and were more likely to receive adjuvant therapy (P = .001) and G-tubes (P = .001). Multivariable regression analysis showed that low SES was a statistically significant predictor of postoperative complications [β 2.50 (95% confidence interval (CI) 0.200, 3.17); P = .014] and LOHS [β 2.03 (95% CI 1.06, 2.99); P = .0001]. Tobacco and alcohol use, clinical tumor, and nodal stage, CCI, and planned adjuvant therapy were also statistically significant predictors of postoperative complications and LOHS (P < .05). Conclusion: Patients with lower SES have more advanced OCSCC disease with increased comorbidities that owes itself to more acute postoperative complications and LOHS within this study population. Patients with low SES should be identified as patients that require more support during their cancer treatment.
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Affiliation(s)
- Michael Xie
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Phillip Staibano
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael K Gupta
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Nhu Tram Nguyen
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Stuart D Archibald
- Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | | | - Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
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Wang C, Lin L, Wu J, Fu G, Liu Z, Cao M. Development and validation of a novel nomogram model for identifying risk of prolonged length of stay among patients receiving free vascularized flap reconstruction of head and neck cancer. Front Oncol 2024; 14:1345766. [PMID: 38764582 PMCID: PMC11099871 DOI: 10.3389/fonc.2024.1345766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/17/2024] [Indexed: 05/21/2024] Open
Abstract
Background The aim of the present study was to build and internally validate a nomogram model for predicting prolonged length of stay (PLOS) among patients receiving free vascularized flap reconstruction of head and neck cancer (HNC). Methods A retrospective clinical study was performed at a single center, examining patients receiving free vascularized flap reconstruction of HNC from January 2011 to January 2019. The variables were obtained from the electronic information system. The primary outcome measure was PLOS. Univariate and multivariate analyses were used to find risk factors for predicting PLOS. A model was then built according to multivariate results. Internal validation was implemented via 1000 bootstrap samples. Results The study included 1047 patients, and the median length of stay (LOS) was 13.00 (11.00, 16.00) days. Multivariate analysis showed that flap types ((radial forearm free flap (odds ratio [OR] = 2.238; 95% CI, 1.403-3.569; P = 0.001), free fibula flap (OR = 3.319; 95% CI, 2.019-4.882; P < 0.001)), duration of surgery (OR = 1.002; 95% CI, 1.001-1.003; P = 0.004), postoperative complications (OR = 0.205; 95% CI, 0.129-0.325; P = P < 0.001) and unplanned reoperation (OR = 0.303; 95% CI, 0.140-0.653; P = 0.002) were associated with PLOS. In addition to these variables, blood transfusion was comprised in the model. The AUC of the model was 0.78 (95% CI, 0.711-0.849) and 0.725 (95% CI, 0.605-0.845) in the primary and internal validation cohorts, respectively. The DCA revealed the clinical utility of the current model when making intervention decisions within the PLOS possibility threshold range of 0.2-0.8. Conclusions Our study developed a nomogram that exhibits a commendable level of accuracy, thereby aiding clinicians in assessing the risk of PLOS among patients receiving free vascularized flap reconstruction for HNC.
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Affiliation(s)
- Chengli Wang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
| | - Liling Lin
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayao Wu
- Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Ganglan Fu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhongqi Liu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei, China
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Ho MH, Li PWC, Lin YK, Lee JJ, Lin CC. Incidence of Postoperative Delirium in Cancer Patients After Head and Neck Surgery: A Proportional Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:335-346. [PMID: 37822138 DOI: 10.1002/ohn.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To summarize the incidence of postoperative delirium among cancer patients undergoing head and neck surgery and determine the differential incidence rates among patients undergoing different types of head and neck surgeries. DATA SOURCES The databases of PubMed, Cochrane Library, Web of Science, EMBASE, and CINAHL were searched from inception till February 2023. Keywords based on the condition (delirium), context (postoperative), and population (head and neck cancer) were used as search terms. REVIEW METHODS The PRISMA and MOOSE reporting guidelines were followed. The Joanna Briggs Institute critical appraisal checklists for cohort studies, case-control studies, and randomized controlled trials were used to evaluate the methodological quality. Data were pooled using a random-effects model, and the incidence with 95% confidence intervals was evaluated using the exact binomial method and Freeman-Tukey double arcsine transformation of proportions. I2 was used to indicate heterogeneity. Predefined subgroup analysis and Meta-regression, was performed to identify the factors affecting heterogeneity. RESULTS The summary incidence of postoperative delirium was 18.95% [95% confidence interval, 14.36%-24.00%] with between-study heterogeneity (I2 = 95.46%). The incidence of postoperative delirium in patients who underwent free flap reconstruction was 22.13%, which was higher than those of other types of surgeries. Meta-regression revealed that conducted in sample size (P = .007) of the included studies was the factors affecting heterogeneity. CONCLUSIONS The evidence on postoperative delirium incidence provided by the current Meta-analysis enables effective treatment planning.
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Affiliation(s)
- Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Polly Wai Chi Li
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Chia-Chin Lin
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Pokfulam, Hong Kong SAR
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List MA, Knackstedt M, Liu L, Kasabali A, Mansour J, Pang J, Asarkar AA, Nathan C. Enhanced recovery after surgery, current, and future considerations in head and neck cancer. Laryngoscope Investig Otolaryngol 2023; 8:1240-1256. [PMID: 37899849 PMCID: PMC10601592 DOI: 10.1002/lio2.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/15/2022] [Indexed: 10/31/2023] Open
Abstract
Objectives Review of the current and relevant literature to develop a list of evidence-based recommendations that can be implemented in head and neck surgical practices. To provide rationale for the multiple aspects of comprehensive care for head and neck surgical patients. To improve postsurgical outcomes for head and neck surgical patients. Methods Extensive review of the medical literature was performed and relevant studies in both the head and neck surgery and other surgical specialties were considered for inclusion. Results A total of 18 aspects of perioperative care were included in this review. The literature search included 276 publications considered to be the most relevant and up to date evidence. Each topic is concluded with recommendation grade and quality of evidence for the recommendation. Conclusion Since it's conception, enhanced recovery after surgery (ERAS) protocols have continued to push for comprehensive and evidence based postsurgical care to improve patient outcomes. Head and neck oncology is one of the newest fields to develop a protocol. Due to the complexity of this patient population and their postsurgical needs, a multidisciplinary approach is needed to facilitate recovery while minimizing complications. Current and future advances in head and neck cancer research will serve to strengthen and add new principles to a comprehensive ERAS protocol. Level of Evidence 2a.
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Affiliation(s)
- Marna A. List
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Mark Knackstedt
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Lucy Liu
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ahmad Kasabali
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- College of MedicineLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Jobran Mansour
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - John Pang
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ameya A. Asarkar
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- Feist‐Weiller Cancer CenterShreveportLouisianaUSA
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Abstract
Striving to optimize surgical outcomes, the Enhanced Recovery After Surgery (ERAS) pathway mitigates patients' stress through the implementation of evidence-based practices during the pre-, intra-, and postoperative periods. Intestinal flora is a sophisticated ecosystem integrating with the host and the external environment, which serves as a mediator in diverse interventions of ERAS to regulate human metabolism and inflammation. This review linked gut microbes and their metabolites with ERAS interventions, offering novel high-quality investigative proponents for ERAS. ERAS could alter the composition and function of intestinal flora in patients by alleviating various perioperative stress responses. Modifying gut flora through multiple modalities, such as diet and nutrition, to accelerate recovery might be a complementary approach when exploring novel ERAS initiatives. Meanwhile, the pandemic of COVID-19 and the availability of promising qualitative evidence created both challenges and opportunities for the establishment of ERAS mode.
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Wang C, Han Z, Wang M, Hu C, Ji F, Cao M, Fu G. Infusion management associated with prolonged length of stay following free flap reconstruction of head and neck defects: A propensity score matching study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e899-e905. [PMID: 35259491 DOI: 10.1016/j.jormas.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical resection of the primary lesion and reconstruction of the defects with free flaps are common treatments for head and neck cancer (HNC). However, various variables can lead to prolonged length of stay (LOS). The aim of this study is to investigate risk factors correlated with prolonged LOS following free flap reconstruction of head and neck defects. METHODS A retrospective study of patients with all types of free flaps reconstruction of HNC between January 2011 and January 2019 at Sun Yat-sen Memorial Hospital was performed. We recorded predictive variables and divided them into: personal and clinical, hemodynamic, anesthetic and surgical. The primary endpoint was prolonged length of stay. Univariate and multivariate analyses were applied to identify risk factors that associated with prolonged LOS. Propensity score matching was performed with the identified risk variables and other perioperative factors that may impact transfusion decision to explore the independent influence of intraoperative blood transfusion on prolonged LOS. RESULTS A total of 1047 patients were included in this study. The median LOS was 13.00 (11.00, 16.00) days. Multivariate analysis suggested that blood transfusion, duration of surgery, postoperative complications and unplanned reoperation were associated with prolonged LOS. After propensity score matching, unnecessary blood transfusion and inadequate fluid rate over 24 h, postoperative complications and unplanned reoperation were identified risk factors that led to prolonged LOS. CONCLUSION Unnecessary blood transfusion and inadequate fluid infusion rate over 24 h were independent risk factors associated with prolonged LOS in HNC patients who underwent free flap reconstruction. Our results indicated consideration of restrictive blood transfusion and adequate fluid infusion over postoperative 24 h in these patients.
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Affiliation(s)
- Chengli Wang
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou 510120, PR China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China
| | - Zhixiao Han
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou 510120, PR China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China
| | - Meng Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China; Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China
| | - Chuwen Hu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou 510120, PR China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China
| | - Fengtao Ji
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou 510120, PR China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou 510120, PR China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China.
| | - Ganglan Fu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou 510120, PR China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China.
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Denis B, Gourbeix C, Coninckx M, Foy JP, Bertolus C, Constantin JM, Degos V. Maxillofacial free flap surgery outcomes in critical care: a single-center investigation looking for clues to improvement. Perioper Med (Lond) 2022; 11:11. [PMID: 35264210 PMCID: PMC8908562 DOI: 10.1186/s13741-022-00244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Maxillofacial surgery for free flap reconstructions is associated with many complications due to technical complexity and comorbidity of patients. With a focus on critical care, the authors studied the impact of complications to highlight predictors of poor postoperative outcomes in order to implement optimization protocols. Methods This case-control study analyzed the relationship between perioperative variables and postoperative medical and surgical complications of patients who underwent head and neck surgery using fibular and forearm free flaps. The primary objective was the incidence of prolonged intensive care unit (ICU) length of stay (LOS). Secondary objectives were the incidence of ICU readmissions, postoperative infections, and 1-year mortality. A univariable logistic regression model was used. A study of mortality was performed with survival analysis. Regarding our primary objective, we performed a Benjamini-Hochberg procedure and a multivariable Poisson regression with defined variables of interest. Results The data of 118 hospital stays were included. Prolonged ICU LOS was observed in 47% of cases and was associated with chronic obstructive pulmonary disease, pneumopathies, intraoperative blood transfusion, and surgical duration. Medical and surgical complications were associated with prolonged ICU LOS. After the Benjamini-Hochberg procedure, infectious complications, complications, major complications, total number of pneumopathies, and operative time remained significant. At least one complication was experienced by 71% of patients during the hospitalization, and 33% of patients suffered from major complications. Infectious complications were the most common (40% of patients) and were mainly caused by pneumonia (25% of patients); these complications were associated with low preoperative hemoglobin level, intraoperative blood transfusion, accumulation of reversible cardiovascular risk factors, chronic alcohol consumption, and duration of surgery. Pneumonia was specifically associated with chronic obstructive pulmonary disease. The ICU readmission rate was 10% and was associated with lower preoperative hemoglobin level, pneumopathies, surgical duration, and use of a fibular flap. The 1-year mortality was 12%, and the survival analysis showed no association with prolonged ICU LOS. Poisson regression showed that ICU LOS was prolonged by smoking history, lower preoperative hemoglobin level, intraoperative blood transfusion, major complication, and pneumopathies. Conclusions Practices such as blood management and respiratory prehabilitation could be beneficial and should be evaluated as a part of global improvement strategies.
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Affiliation(s)
- Bruno Denis
- Department of Anesthesia and Intensive Care, Pitié-Salpêtrière Hospital, Boulevard de l'Hôpital 47-83, 75013, Paris, France. .,Intensive Care Unit, Saint-Luc Hospital, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Claire Gourbeix
- Department of Anesthesia and Intensive Care, Pitié-Salpêtrière Hospital, Boulevard de l'Hôpital 47-83, 75013, Paris, France
| | - Marine Coninckx
- Maxillofacial Surgery Unit, Pitié-Salpêtrière Hospital, Boulevard de l'Hôpital 47-83, 75013, Paris, France
| | - Jean-Philippe Foy
- Maxillofacial Surgery Unit, Pitié-Salpêtrière Hospital, Boulevard de l'Hôpital 47-83, 75013, Paris, France
| | - Chloé Bertolus
- Maxillofacial Surgery Unit, Pitié-Salpêtrière Hospital, Boulevard de l'Hôpital 47-83, 75013, Paris, France
| | - Jean-Michel Constantin
- Department of Anesthesia and Intensive Care, Pitié-Salpêtrière Hospital, Boulevard de l'Hôpital 47-83, 75013, Paris, France
| | - Vincent Degos
- Department of Anesthesia and Intensive Care, Pitié-Salpêtrière Hospital, Boulevard de l'Hôpital 47-83, 75013, Paris, France
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Gao J, Tseng CC, Barinsky GL, Povolotskiy R, Grube JG, Baredes S, Park RCW. Exploratory analysis on the association of mental health disorders with in-hospital postoperative complications and mortality in head and neck cancer surgery. Head Neck 2021; 43:3022-3031. [PMID: 34180571 DOI: 10.1002/hed.26791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/16/2021] [Accepted: 06/10/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The objective was to assess the association of mental health disorders with in-hospital complication and mortality rates in patients undergoing head and neck cancer surgery. METHODS In this exploratory retrospective study, the Nationwide Inpatient Sample was queried from 2003 to 2014 for all patients with a diagnosis of head and neck cancer who underwent surgery. Univariate cross-tabulation, logistic regression, and propensity score matching (PSM) were used to compare demographics, procedure-related variables, and in-hospital postoperative complications and mortality between patients with and without selected comorbid mental health disorders. RESULTS Of 39 600 included patients, 3390 (8.6%) had a selected comorbid mental health disorder diagnosis. After PSM, patients with selected mental health disorders had increased risk of overall medical complications on multivariable analysis (OR 1.28 [CI 1.12-1.46], P < 0.001) but not overall surgical complications or mortality. CONCLUSIONS Patients with a mental health disorder diagnosis have increased risk of in-hospital medical, certain surgical, and total complications.
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Affiliation(s)
- Jeff Gao
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Roman Povolotskiy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Lindeborg MM, Sethi RKV, Puram SV, Parikh A, Yarlagadda B, Varvares M, Emerick K, Lin D, Durand ML, Deschler DG. Predicting length of stay in head and neck patients who undergo free flap reconstruction. Laryngoscope Investig Otolaryngol 2020; 5:461-467. [PMID: 32596488 PMCID: PMC7314462 DOI: 10.1002/lio2.410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Understanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS. METHODS A retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS. RESULTS A total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF-73.8%, anterolateral thigh flap-11.3%, and fibula free flap-14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [C] = +4.26, P < .0001), in-hospital PNA or UTI (C = +2.52, P = .037), wound breakdown or fistula (C = +5.0, P < .0001), surgical site infection (C = +3.54, P = .017), and prior radiation therapy (C = +2.59, P = .004). CONCLUSION Several perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution-level protocols for postoperative care and disposition of free flap patients. LEVEL OF EVIDENCE 2b; retrospective cohort.
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Affiliation(s)
- Michael M. Lindeborg
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Rosh K. V. Sethi
- Department of OtolaryngologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sidharth V. Puram
- Department of OtolaryngologyWashington University School of Medicine in Saint LouisSaint LouisMissouriUSA
| | - Anuraag Parikh
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Bharat Yarlagadda
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Mark Varvares
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Kevin Emerick
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Derrick Lin
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Marlene L. Durand
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Daniel G. Deschler
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
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Densky J, Eskander A, Kang S, Chan J, Tweel B, Sitapara J, Ozer E, Agrawal A, Carrau R, Rocco J, Teknos TN, Old M. Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction. JAMA Otolaryngol Head Neck Surg 2020; 145:216-221. [PMID: 30605208 DOI: 10.1001/jamaoto.2018.3820] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Postoperative delirium (POD) is associated with an increased rate of adverse events, higher health care costs, and longer hospital stays. At present, limited data are available regarding the risk factors for developing POD in patients undergoing head and neck free flap reconstruction. Identification of patients at high risk of developing POD will allow implementation of risk-mitigation strategies. Objective To determine the frequency of and risk factors associated with POD in patients undergoing free flap reconstruction secondary to head and neck disease. Design, Setting, and Participants This retrospective cohort study included 515 patients undergoing free flap reconstruction from January 1, 2006, through December 31, 2012, at the James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Care Center, a tertiary care cancer hospital. Preoperative, intraoperative, and postoperative data were collected retrospectively. Data from January 1, 2006, through December 31, 2012, were analyzed, and the final date of data analysis was January 8, 2018. Interventions Head and neck free flap reconstruction. Main Outcomes and Measures The primary outcome was the development of POD as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Univariable and multivariable logistic regression were used to identify risk factors associated with POD. Results Five hundred fifteen patients underwent free flap reconstruction during the study period (66.2% male; mean [SD] age, 60.1 [12.8] years). Of these, 56 patients (10.9%) developed POD. On multivariable analysis, risk factors associated with POD included increased age (odds ratio [OR], 1.06; 95% CI, 1.02-1.11), male sex (OR, 5.02; 95% CI, 1.47-17.20), increased operative time (OR for each 1-minute increase, 1.004 [95% CI, 1.001-1.006]; OR for each 1-hour increase, 1.26 [95% CI, 1.08-1.46]), advanced nodal disease (OR, 3.00; 95% CI, 1.39-6.46), and tobacco use (OR, 7.23; 95% CI, 1.43-36.60). Preoperative abstinence from alcohol was identified as a protective factor (OR, 0.24; 95% CI, 0.12-0.51). Conclusions and Relevance This study identified variables associated with a higher risk of developing POD. Although many of these risk factors are nonmodifiable, they provide a target population for quality improvement initiatives. Furthermore, preoperative alcohol abstinence may be useful in preventing POD.
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Affiliation(s)
- Jaron Densky
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Stephen Kang
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Jon Chan
- Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond
| | - Ben Tweel
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jigar Sitapara
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Enver Ozer
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Amit Agrawal
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Ricardo Carrau
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - James Rocco
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Ted N Teknos
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
| | - Matthew Old
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus
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11
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Sahara K, Paredes AZ, Mehta R, Hyer JM, Tsilimigras DI, Merath K, Farooq SA, Wu L, Moro A, Beal EW, Endo I, Pawlik TM. Potential disease burden of patients with substance abuse undergoing major abdominal surgery: A propensity score-matched analysis. Surgery 2019; 166:1181-1187. [PMID: 31378476 DOI: 10.1016/j.surg.2019.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/08/2019] [Accepted: 06/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Over 19 million Americans have a substance abuse disorder. The current study sought to characterize the relationship between substance abuse with in-hospital outcomes following major, elective abdominal surgery. METHODS The Nationwide Inpatient Sample was used to identify patients who underwent major abdominal surgery between 2007 to 2014. Patients with preoperative substance abuse, including alcohol, opioids, and non-opioid drugs, were identified. Propensity score matching was used to examine the association of substance abuse with perioperative outcomes. RESULTS Among 301,659 patients, 7,925 patients (2.6%) had a history of substance abuse. Pancreatectomy was the surgical procedure with the highest proportion of patients with substance abuse history (n = 844, 4.7%). Compared with patients without a substance abuse history, patients with a substance abuse history were more likely to be younger (median age, 60 years [interquartile range (IQR) 52-69] vs 63 years [IQR 52-72]), male (n = 5,438, 67.5% vs n = 132,961, 54.7%), and be in the lowest income category (n = 2,062, 26% vs n = 64,345, 21.9%) (all P < .001). On propensity score matching, substance abuse was associated with increased odds ratio of experiencing a complication (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.55-1.82), non-home discharge (OR 1.95, 95% CI 1.76-2.16), extended length of stay (OR 1.88, 95% CI 1.76-2.02), and higher expenditure (OR 1.62, 95% CI 1.49-1.77). Stratified by the type of substance abuse, patients with history of alcohol (OR 1.57, 95% CI 1.44-1.71) and drug abuse (OR 1.26, 95% CI 1.14-1.39) were more likely to experience a complication, whereas only history of alcohol abuse was associated with higher odds ratio of in-hospital mortality (OR 1.38, 95% CI 1.07-1.79) (all P < .05). CONCLUSION Up to 1 in 50 patients undergoing complex abdominal surgery had a substance abuse history. History of substance abuse was associated with an increased risk of adverse perioperative outcomes and higher healthcare expenditures.
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Affiliation(s)
- Kota Sahara
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; Gastroenterological Surgery Division, Yokohama City University School of Medicine, Japan
| | - Anghela Z Paredes
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Rittal Mehta
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - J Madison Hyer
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Diamantis I Tsilimigras
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Katiuscha Merath
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Syeda A Farooq
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Lu Wu
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Amika Moro
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Eliza W Beal
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Itaru Endo
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Japan
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
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12
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Old M. Failure to Report Related Studies. JAMA Otolaryngol Head Neck Surg 2019; 145:293-294. [PMID: 30816922 DOI: 10.1001/jamaoto.2019.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matthew Old
- The James Cancer Hospital and Solove Research Institute, Wexner Medical Center, Division of Head & Neck Oncology, Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus
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13
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Egholm JWM, Pedersen B, Møller AM, Adami J, Juhl CB, Tønnesen H. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database Syst Rev 2018; 11:CD008343. [PMID: 30408162 PMCID: PMC6517044 DOI: 10.1002/14651858.cd008343.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Risky consumption of alcohol is a global problem. More than 3.3 million deaths annually are associated with risky use of alcohol, and global alcohol consumption continues to increase. People who have high alcohol consumption often require planned and emergency surgical procedures.Risky drinking is associated with increased postoperative complications such as infections, cardiopulmonary complications, and bleeding episodes. Alcohol causes disorders of the liver, pancreas, and nervous system. Stopping consumption of alcohol can normalize these organ systems to some degree and may reduce the occurrence of complications after surgery.This review was first published in 2012 and was updated in 2018. OBJECTIVES To assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. SEARCH METHODS We searched the following databases up until 21 September 2018: Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; CINAHL via EBSCOhost; and two trials registers. We scanned the reference lists and citations of included trials and any identified relevant systematic reviews for further references to additional trials. When necessary, we contacted trial authors to ask for additional information. SELECTION CRITERIA We included all randomized controlled trials (RCTs) that evaluated the effects of perioperative alcohol cessation interventions on postoperative complications and alcohol consumption. We included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered a perioperative alcohol cessation intervention or no intervention.We defined 'risky drinking' as alcohol consumption equivalent to more than 3 alcoholic units (AU)/d or 21 AU/week (with 1 AU containing 12 grams of ethanol) with or without symptoms of alcohol abuse or dependency. This corresponds to the amount of alcohol associated with increased postoperative complication rates in most clinical studies. DATA COLLECTION AND ANALYSIS We used guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. We presented main outcomes as dichotomous variables in a meta-analysis. When data were available, we conducted subgroup and sensitivity analyses to explore the risk of bias. Primary outcome measures were postoperative complications and in-hospital and 30-day mortality. Secondary outcomes were successful quitting at the end of the programme, postoperative alcohol use, and length of hospital stay. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included in this updated review one new study (70 participants), resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.Overall, 53 of the 122 participants from three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.In-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.Investigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.All three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the standard deviation (SD). We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term. AUTHORS' CONCLUSIONS This systematic review assessed the efficacy of perioperative alcohol cessation interventions for postoperative complications and alcohol consumption. All three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.Included studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomized controlled trials is needed. Once published and assessed, the one 'ongoing' study identified may alter the conclusions of this review.
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Affiliation(s)
- Julie WM Egholm
- Hospital of Southern Jutland, University of Southern DenmarkOrthopaedic DepartmentAabenraaDenmark6200
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
| | - Bolette Pedersen
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
- Lund UniversityDepartment of Health SciencesLundSweden
| | - Ann Merete Møller
- Herlev and Gentofte Hospital, University of CopenhagenCochrane Anaesthesia, Critical and Emergency Care GroupHerlev RingvejHerlevDenmark2730
| | - Johanna Adami
- Sophiahemmet UniversityLindstedtsvägen 8StockholmSweden
| | - Carsten B Juhl
- University of Southern DenmarkSEARCH (Research group for synthesis of evidence and research), Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical BiomechanicsCampusvej 55Odense MDenmark5230
| | - Hanne Tønnesen
- Hospital of Southern Jutland, University of Southern DenmarkOrthopaedic DepartmentAabenraaDenmark6200
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
- Lund UniversityDepartment of Health SciencesLundSweden
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14
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Eskander A, Kang S, Tweel B, Sitapara J, Old M, Ozer E, Agrawal A, Carrau R, Rocco JW, Teknos TN. Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures. Otolaryngol Head Neck Surg 2018; 158:839-847. [DOI: 10.1177/0194599818757949] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Stephen Kang
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Ben Tweel
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jigar Sitapara
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Matthew Old
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Amit Agrawal
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Ricardo Carrau
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - James W. Rocco
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
| | - Theodoros N. Teknos
- Department of Otolaryngology–Head & Neck Surgery, Division of Head & Neck Oncology, Ohio State University, James Cancer Centre and Solove Research Institute, Columbus, Ohio, USA
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15
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Graf SA, Zeliadt SB, Rise PJ, Backhus LM, Zhou XH, Williams EC. Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection. J Thorac Dis 2018; 10:1648-1656. [PMID: 29707317 DOI: 10.21037/jtd.2018.02.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Lung resections carry a significant risk of complications necessitating the characterization of peri-operative risk factors. Unhealthy alcohol use represents one potentially modifiable factor. In this retrospective cohort study, the largest to date of lung resections in the Veterans Health Administration (VHA), we examined the association between unhealthy alcohol use and postoperative complications and mortality. Methods Veterans Affairs Surgical Quality Improvement Program data recorded at 86 medical centers between 2007 and 2011 were used to identify 4,715 patients that underwent lung resection. Logistic regression models, adjusted for demographics and comorbidities, were fit to assess the association between unhealthy alcohol use (report of >2 drinks per day in the 2 weeks preceding surgery) and 30-day outcomes. Results Among 4,715 patients that underwent pulmonary resection, 630 (13.4%) reported unhealthy alcohol use (>2 drinks/day). Overall, postoperative complications occurred in 896 (19.0%) patients, including pneumonia in 524 (11.1%). The rate of mortality was 2.6%. In adjusted analyses, complications were significantly more common among patients with unhealthy alcohol use [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.15-1.74] including, specifically, pneumonia (OR, 1.69; 95% CI, 1.32-2.15). No statistically significant association was identified between unhealthy alcohol use and mortality (OR, 1.27; 95% CI, 0.75-2.02). In secondary analyses that stratified by smoking status at the time of surgery, drinking more than 2 drinks per day was associated with post-operative complications in patients reporting current smoking (OR, 1.51; 95% CI, 1.18-1.91) and was not identified in those reporting no current smoking at the time of surgery (OR, 1.23; 95% CI, 0.79-1.85). Conclusions In this large VHA study, 13% of patients undergoing lung resection reported drinking more than 2 drinks per day in the preoperative period, which was associated with increased risk of post-operative complications. Unhealthy alcohol use may be an important target for perioperative risk-mitigation interventions, particularly in patients who report current smoking.
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Affiliation(s)
- Solomon A Graf
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA, USA
| | - Steven B Zeliadt
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Peter J Rise
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Leah M Backhus
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Xiao-Hua Zhou
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Emily C Williams
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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