Sangal NR, et al. - Researchers sought for the risk factors associated with unplanned reoperation following major head and neck surgery. In this cohort study, using the American College of Surgeons National Surgical Quality Improvement Program database, they identified that reoperation was performed on 14% of patients (275 of 1941) following glossectomy, mandibulectomy, laryngectomy, or pharyngectomy. Black race, disseminated cancer, total operation time, superficial and deep surgical site infections, wound dehiscence and ventilator dependence were identified as the independent factors associated with reoperation.

Methods

• For this retrospective cohort study, researchers identified 2475 cases of major operations of the head and neck performed between 2005 and 2014 via searching the American College of Surgeons National Surgical Quality Improvement Program database.
• They specifically analyzed glossectomy, mandibulectomy, laryngectomy, and pharyngectomy.
• Demographic and clinical characteristics of patients with or without unplanned reoperation were compared via performing univariate and multivariate analyses.
• Analysis of data was performed between September and November 2017.
• Incidence of unplanned reoperation in patients with major operations in the head and neck region was assessed as the primary outcome.
• Additionally, they assessed the risk factors associated with an increased likelihood of reoperation.

Results

•  In total, researchers included 1941 patients (1298 [66.9%] males), with most patients (961 [49.5%]) between 61 and 80 years of age.
• After the principal operative procedure, unplanned reoperation within 30 days was performed on 14.2% of patients (275 patients).
• In this study, the highest reoperation rate was noted with 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%]).
• Reoperation was performed on 516 patients (76.8%) during their initial hospital admission and on 156 patients (23.2%) after readmission.
• For initial-admission reoperations and readmission reoperations, the mean (SD) number of days from the principal operative procedure to unplanned reoperation were 8.5 (3.6) days and 16.0 (4.8) days, respectively.
• Unplanned reoperation procedures most commonly performed were 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%]).
• As per multivariate analysis, unplanned reoperation following a major cancer operation of the head or neck was independently associated with 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).