Zaid Al-Qurayshi1, Christopher Blake Sullivan1, Nitin Pagedar1, Gregory Randolph2,3, Emad Kandil4. 1. Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. 2. Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA. 3. Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA. 4. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Abstract
BACKGROUND: The objectives of the study is to examine the prevalence and burden of major structures injury (pharynx, esophagus, trachea, larynx, lymphatic, vessels & nerves) in patients who underwent thyroid, parathyroid, and neck dissection surgeries in the United States. METHODS: The study is a retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database, 2010-2015. The study population included adults (≥18 years) patients who underwent thyroid, parathyroid, and neck dissection surgeries. RESULTS: A total of 54,443 patients were included. Major structures injury was reported in 221 (0.48%) patients. The injured structures were vascular (0.22%), lymphatic (0.18%), pharynx/esophagus (0.06%), neural (0.03%), and trachea/larynx (0.002%). The risk of injury increased annually during the study period (OR: 1.29, 95% CI: 1.16, 1.44, P<0.001). The risk of injury was highest in patients who underwent thyroidectomy with neck dissection (1.01%) or neck dissection alone (1.81%) (P<0.001 each). The risk was also highest for patients with a head and neck cancer diagnosis (OR: 1.80, 95% CI: 1.24, 2.61, P=0.002). Patients with those injuries had a higher prevalence of blood transfusion (2.82% vs. 0.17%), postoperative fistula (3.10% vs. 0.03%), readmission (28.90% vs. 3.59%), and postoperative mortality (0.87% vs. 0.06%) (P<0.05 each). Management of patients with those injuries was associated with a longer hospital stay by 4.86±0.48 days (P<0.001), and a higher cost by $16,151.00±173.36 (P<0.001). CONCLUSIONS: Injuries of major structures in thyroid and neck surgeries are more prevalent in cancer patients. There has been a recent increase in the risk of such injuries in the United States. Those injuries are associated with significant clinical and economic burden. 2020 Gland Surgery. All rights reserved.
BACKGROUND: The objectives of the study is to examine the prevalence and burden of major structures injury (pharynx, esophagus, trachea, larynx, lymphatic, vessels & nerves) in patients who underwent thyroid, parathyroid, and neck dissection surgeries in the United States. METHODS: The study is a retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database, 2010-2015. The study population included adults (≥18 years) patients who underwent thyroid, parathyroid, and neck dissection surgeries. RESULTS: A total of 54,443 patients were included. Major structures injury was reported in 221 (0.48%) patients. The injured structures were vascular (0.22%), lymphatic (0.18%), pharynx/esophagus (0.06%), neural (0.03%), and trachea/larynx (0.002%). The risk of injury increased annually during the study period (OR: 1.29, 95% CI: 1.16, 1.44, P<0.001). The risk of injury was highest in patients who underwent thyroidectomy with neck dissection (1.01%) or neck dissection alone (1.81%) (P<0.001 each). The risk was also highest for patients with a head and neck cancer diagnosis (OR: 1.80, 95% CI: 1.24, 2.61, P=0.002). Patients with those injuries had a higher prevalence of blood transfusion (2.82% vs. 0.17%), postoperative fistula (3.10% vs. 0.03%), readmission (28.90% vs. 3.59%), and postoperative mortality (0.87% vs. 0.06%) (P<0.05 each). Management of patients with those injuries was associated with a longer hospital stay by 4.86±0.48 days (P<0.001), and a higher cost by $16,151.00±173.36 (P<0.001). CONCLUSIONS: Injuries of major structures in thyroid and neck surgeries are more prevalent in cancer patients. There has been a recent increase in the risk of such injuries in the United States. Those injuries are associated with significant clinical and economic burden. 2020 Gland Surgery. All rights reserved.
Entities:
Keywords:
Head and neck surgery; chyle leak; esophagus injury; nerve injury; vascular injury
Authors: Christine G Gourin; Ralph P Tufano; Arlene A Forastiere; Wayne M Koch; Timothy M Pawlik; Robert E Bristow Journal: Arch Otolaryngol Head Neck Surg Date: 2010-12
Authors: Alex B Haynes; Thomas G Weiser; William R Berry; Stuart R Lipsitz; Abdel-Hadi S Breizat; E Patchen Dellinger; Teodoro Herbosa; Sudhir Joseph; Pascience L Kibatala; Marie Carmela M Lapitan; Alan F Merry; Krishna Moorthy; Richard K Reznick; Bryce Taylor; Atul A Gawande Journal: N Engl J Med Date: 2009-01-14 Impact factor: 91.245
Authors: S A R Nouraei; J Allen; H Kaddour; S E Middleton; P Aylin; A Darzi; N S Tolley Journal: Clin Otolaryngol Date: 2017-07-20 Impact factor: 2.597
Authors: Andrew B Baker; Adrian A Ong; Brendan P O'Connell; Alexander D Sokohl; William B Clinkscales; Ted A Meyer Journal: Laryngoscope Date: 2017-05-23 Impact factor: 3.325
Authors: Rafael De la Garza Ramos; Jonathan Nakhla; Rani Nasser; Ajit Jada; Daniel M Sciubba; Merritt D Kinon; Reza Yassari Journal: World Neurosurg Date: 2016-11-30 Impact factor: 2.104