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Attia AS, Hussein M, Youssef MR, Omar M, Elnahla A, Farhoud A, Zora G, Reisner ASC, McClure B, Cox KS, Toraih E, Randolph GW, Kandil E. Deciphering excess healthcare burden in head and neck cancer patients with cardiovascular comorbidity. J Surg Oncol 2022; 125:968-975. [PMID: 35088904 DOI: 10.1002/jso.26802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to determine the perioperative surgical outcomes for head and neck cancer patients with cardiovascular diseases (CVDs). METHODS A cross-sectional analysis was performed using data from the Nationwide Readmissions Database between 2010 and 2014. Logistic regression analysis by enter and backward stepwise methods were used. RESULTS A total of 8346 patients met the inclusion criteria. Patients with concomitant CVD had a higher frequency of complications (57.6%) compared with those without (47.4%) (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.23-1.48, p < 0.001). Patients with CVD comorbidities were prone to experience in-patient mortality at both admission (OR = 2.4, 95% CI = 1.42-4.05) and readmission (OR = 2.55, 95% CI = 1.10-5.87). CVD patients have prolonged hospital admission (OR = 1.14, 95% CI = 1.02-1.27, p = 0.020) and higher cost (OR = 1.28, 95% CI = 1.15-1.43, p < 0.001). Patients with congestive heart failure were prone to 30 days readmission (OR = 1.67, 95% CI = 1.10-2.53, p = 0.019) and 90 days (OR = 1.65, 95% CI = 1.14-2.39, p = 0.010). CONCLUSION This is the first study identifying factors predicting higher risk of perioperative complications of surgical management of head and neck cancer. Those with CVD had higher risk of adverse events.
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Affiliation(s)
- Abdallah S Attia
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohammad Hussein
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohanad R Youssef
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mahmoud Omar
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ahmed Elnahla
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ashraf Farhoud
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ghassan Zora
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Adin S C Reisner
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brian McClure
- Department of Anesthesiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Katherine S Cox
- Department of Anesthesiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Eman Toraih
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Genetics Unit, Histology and Cell Biology Department, Suez Canal University, Ismailia, Egypt
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Emad Kandil
- Endocrine and Oncology Division, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Hussein M, Toraih E, Reisner ASC, Miller P, Corsetti R, Kandil E. Prevalence and mortality of cardiovascular events in patients with hyperthyroidism: a nationwide cohort study in the United States. Gland Surg 2021; 10:2608-2621. [PMID: 34733711 DOI: 10.21037/gs-21-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022]
Abstract
Background Little is known about the implications of hyperthyroidism on cardiovascular diseases like myocardial infarctions (MI), ischemic strokes, and hemorrhagic strokes. Previous studies implicate hyperthyroidism as a risk factor for MI and ischemic stroke. Cardiovascular disease is the leading cause of death in the US, and the possibility of hyperthyroidism contributing to this disease burden warrants investigation in a US patient population. Methods The National Readmission Database (NRD) from 2010 to 2017 was used to identify adults who had a new-onset diagnosis of MI, ischemic stroke, or hemorrhagic stroke. Risk factors for mortality, prolonged hospital stay, and hospital cost were analyzed with binary logistic regression. Results A total of 278,609,748 hospital records were reviewed. Of these, 15,685,461 were hospitalized for adverse cardiovascular events with concomitant hyperthyroidism, roughly 4.5 per 1,000 cases. Patients with MI and hemorrhagic stroke with thyrotoxicosis had a lower mortality rate than euthyroid patients (OR 0.81, 95% CI: 0.78-0.84, P<0.001 and OR 0.72, 95% CI: 0.67-0.77, P<0.001, respectively). Thyrotoxicosis was associated with increased hospital stay (MI: OR 1.35, 95% CI: 1.32-1.38, P<0.001; ischemic: OR 1.38, 95% CI: 1.35-1.41, P<0.001; hemorrhagic: OR 1.33, 95% CI: 1.25-1.40, P<0.001), expenditures in ischemic (OR 1.31, 95% CI: 1.28-1.34, P<0.001) and hemorrhagic stroke patients (OR 1.18, 95% CI: 1.12-1.24, P<0.001). Conclusions Patients that experienced MI or hemorrhagic stroke with concomitant thyrotoxicosis were observed to have a lower mortality rate than euthyroid patients but had with an increased length of hospital stay. Patients who had ischemic or hemorrhagic stroke with thyrotoxicosis had a significantly higher hospital cost. The hyperdynamic state underlying hyperthyroidism may be protective in these adverse events. Further studies into these physiological changes are warranted.
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Affiliation(s)
- Mohammad Hussein
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Eman Toraih
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA.,Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Peter Miller
- Tulane University, School of Medicine, New Orleans, LA, USA
| | - Ralph Corsetti
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
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Youssef MR, Reisner ASC, Attia AS, Hussein MH, Omar M, LaRussa A, Galvani CA, Aboueisha M, Abdelgawad M, Toraih EA, Randolph GW, Kandil E. Obesity and the prevention of thyroid cancer: Impact of body mass index and weight change on developing thyroid cancer - Pooled results of 24 million cohorts. Oral Oncol 2020; 112:105085. [PMID: 33171329 DOI: 10.1016/j.oraloncology.2020.105085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Body weight may be a modifiable risk factor predisposing to different cancers. To establish a potential impact of weight change on thyroid cancer risk, we conducted a meta-analysis to evaluate the effect of body mass index (BMI) and weight change over time as a risk of developing thyroid cancer (TC). METHODS A systematic search was performed up to February 25, 2020. Pooled relative risk (RR) were estimated using fixed and random models. Heterogeneity between articles was examined using Q-test and I2 index. Evaluation of publication bias was conducted with Egger's regression test. RESULTS A total of 31 studies including 24,489,477 cohorts were eligible. Pooled analysis revealed that normal and underweight cohorts were associated with a decreased risk of TC (RR = 0.68, 95%CI = 0.65-0.71, p < 0.001) and (RR = 0.92, 95%CI = 0.91-0.93, p < 0.001), respectively. In contrast, overweight and obese cohorts were more likely to develop TC (RR = 1.26, 95%CI = 1.24-1.28, p < 0.001 and RR = 1.50, 95%CI = 1.45-1.55, p < 0.001, respectively). Obesity was associated with higher risk of developing TC among women (RR = 1.29, 95%CI = 1.14-1.46, p < 0.001), but not men (RR = 1.25, 95%CI = 0.97-1.62, p = 0.08). Furthermore, weight gain increased the risk of developing TC (RR = 1.18, 95%CI = 1.14-1.22, p < 0.001), while weight loss decreased the risk (RR = 0.89, 95%CI = 0.85-0.93, p < 0.001). Results showed similar trends of weight change effect in both males and females. CONCLUSIONS Obesity is associated with higher risk of developing TC in women. However, maintaining a healthy weight is associated with reduced risk of TC in both women and men. Shifting our practice to include weight control strategies will help lead to cancer prevention.
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Affiliation(s)
- Mohanad R Youssef
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | | | - Abdallah S Attia
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | | | - Mahmoud Omar
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Anna LaRussa
- Tulane University, School of Medicine, New Orleans, LA, USA
| | - Carlos A Galvani
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Aboueisha
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
| | - Mohamed Abdelgawad
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA; Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Eman Ali Toraih
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA; Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA.
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