Sangal NR, et al. - Researchers sought to identify risk factors of unplanned reoperation following major operations of the head and neck. The incidence of unplanned reoperation in patients with major operations in the head and neck region was included in the primary outcome. Findings suggested that the identification of a significant association of black race, disseminated cancer, total operation time, surgical site infection in either the superficial or deep spaces, wound dehiscence, or ventilator dependence for more than 48 hours after surgery with increased risk of reoperation in major head and neck surgery may guide the modification and adaptation of these risk factors to decrease the burden that unplanned reoperation places on patients, surgeons, and the health care system.

Methods

• In this retrospective cohort study, researchers queried the American College of Surgeons National Surgical Quality Improvement Program database and identified 2,475 cases of major operations of the head and neck performed between 2005 and 2014.
• Glossectomy, mandibulectomy, laryngectomy, and pharyngectomy were the specific operations analyzed.
• They performed univariate and multivariate analyses to compare demographic and clinical characteristics of patients with or without unplanned reoperation.
• They evaluated the data between September and November 2017.
• The primary outcome included the incidence of unplanned reoperation in patients with major operations in the head and neck region.
• They additionally evaluated the risk factors associated with an increased likelihood of reoperation.

Results

• Experts included 1,941 patients in this study (1298 [66.9%] males), with most patients (961 [49.5%]) between 61 and 80 years of age.
• They noted 14.2% (275 patients) to be the overall unplanned reoperation rate within 30 days after the principal operative procedure.
• 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%]) were the operative procedure with the highest reoperation rate.
• Findings suggested that among the unplanned reoperation patients, reoperation was done in 516 patients (76.8%) during their initial hospital admission and 156 patients (23.2%) after readmission.
• For initial-admission reoperations, the mean (SD) number of days from the principal operative procedure to unplanned reoperation was 8.5 (3.6) days and 16.0 (4.8) days for readmission reoperations.
• On arteries and veins (47 of 2475 [1.9%]), the most common unplanned reoperation procedures overall included repair, surgical exploration, and revision procedures, on the soft tissue of the neck and thorax (37 of 1941 [1.9%]) it included incision procedures, and incision and drainage procedures on the skin, subcutaneous, and accessory structures (21 of 1941 [1.1%]).
• Results demonstrated that multivariate analysis results indicated that the independent risk factors for unplanned reoperation following a major cancer operation of the head or neck included 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).