PMID- 30789650
OWN - NLM
STAT- MEDLINE
DCOM- 20200220
LR  - 20221207
IS  - 2168-619X (Electronic)
IS  - 2168-6181 (Print)
IS  - 2168-6181 (Linking)
VI  - 145
IP  - 4
DP  - 2019 Apr 1
TI  - Evaluation of a Preoperative Adverse Event Risk Index for Patients Undergoing 
      Head and Neck Cancer Surgery.
PG  - 345-351
LID - 10.1001/jamaoto.2018.4513 [doi]
AB  - IMPORTANCE: Patients 65 years or older are the most frequent users of operative 
      resources and are also the most vulnerable to postoperative adverse events (AEs). 
      Frailty indices are increasingly being used for preoperative risk stratification 
      within head and neck cancer surgery, but most models lack a multifactorial basis 
      and cannot be directly applied to clinical practice. A practical risk index is 
      needed for clinicians to gauge risk factors preoperatively. OBJECTIVE: To develop 
      a preoperative risk index of short-term major postoperative AEs for patients 
      undergoing head and neck cancer surgery. DESIGN: Cohort analysis of patients from 
      multiple medical centers undergoing inpatient ablative or reconstructive head and 
      neck cancer surgery and registered in the American College of Surgeons (ACS) 
      National Surgical Quality Improvement Program (NSQIP) from 2006 to 2016. 
      EXPOSURES: Inpatient ablative or reconstructive head and neck cancer surgery. 
      MAIN OUTCOMES AND MEASURES: Sociodemographic, frailty-related, and surgical 
      factors in the derivation cohort were evaluated using simple and multiple 
      logistic regression. Risk factors were subsequently integrated into a 
      preoperative head and neck surgery risk index (HNSRI) and compared with existing 
      models using the validation cohort. A composite variable of major postoperative 
      AEs was used, including death within 30 days of surgery. RESULTS: A total of 
      43 968 operations were found using the ACS NSQIP database. Of these, 12 569 cases 
      were excluded as non-head and neck cancer or emergency surgery. Of the included 
      31 399 operations reviewed, the mean (SD) patient age was 56.9 (15.4) years, and 
      16 994 of the patients were women (54.1%). A total of 4556 (14.5%) patients had a 
      major postoperative AE, and 209 (0.7%) died. Older age, male sex, smoking, 
      anticoagulation, recent weight loss, functional dependence, free-tissue transfer, 
      tracheotomy, duration of surgery, wound classification, anemia, leukocytosis, and 
      hypoalbuminemia were independently associated with major AEs or death on multiple 
      regression analysis (C statistic, 0.83). The area under the curve of the HNSRI to 
      predict major AEs including death using the validation cohort (n = 15 699) was 
      0.84 (95% CI, 0.83-0.85) with a sensitivity of 80.1% (95% CI, 79.4%-80.8%) and 
      specificity, 72.3% (95% CI, 70.3%-74.2%). The HNSRI outperformed existing risk 
      models for prediction of AEs: delta C index of the HNSRI to the modified frailty 
      index 11, 0.23 (95% CI, 0.22-0.25); the American Society of Anesthesiologists 
      classification, 0.14 (95% CI, 0.13-0.16); and the ACS risk calculator, 0.02 (95% 
      CI, 0.01-0.03). CONCLUSIONS AND RELEVANCE: The proposed HNSRI demonstrated a high 
      sensitivity and specificity for major postoperative AEs and death in the studied 
      population. This risk index can be used to counsel patients awaiting head and 
      neck cancer surgery.
FAU - Mascarella, Marco Antonio
AU  - Mascarella MA
AD  - Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, 
      Quebec, Canada.
AD  - Department of Epidemiology, Biostatistics and Occupational Health, McGill 
      University, Montreal, Quebec, Canada.
FAU - Richardson, Keith
AU  - Richardson K
AD  - Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, 
      Quebec, Canada.
FAU - Mlynarek, Alex
AU  - Mlynarek A
AD  - Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, 
      Quebec, Canada.
FAU - Forest, Veronique-Isabelle
AU  - Forest VI
AD  - Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, 
      Quebec, Canada.
FAU - Hier, Michael
AU  - Hier M
AD  - Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, 
      Quebec, Canada.
FAU - Sadeghi, Nader
AU  - Sadeghi N
AD  - Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, 
      Quebec, Canada.
FAU - Mayo, Nancy
AU  - Mayo N
AD  - Department of Epidemiology, Biostatistics and Occupational Health, McGill 
      University, Montreal, Quebec, Canada.
AD  - School of Physical and Occupational Health, McGill University, Montreal, Quebec, 
      Canada.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JAMA Otolaryngol Head Neck Surg
JT  - JAMA otolaryngology-- head & neck surgery
JID - 101589542
SB  - IM
MH  - Ablation Techniques/*adverse effects
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Head and Neck Neoplasms/complications/pathology/*surgery
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*etiology
MH  - Quality Improvement
MH  - Plastic Surgery Procedures/*adverse effects
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
PMC - PMC6481426
COIS- Conflict of Interest Disclosures: None reported.
EDAT- 2019/02/23 06:00
MHDA- 2020/02/23 06:00
PMCR- 2020/02/21
CRDT- 2019/02/22 06:00
PHST- 2019/02/23 06:00 [pubmed]
PHST- 2020/02/23 06:00 [medline]
PHST- 2019/02/22 06:00 [entrez]
PHST- 2020/02/21 00:00 [pmc-release]
AID - 2725439 [pii]
AID - ooi180116 [pii]
AID - 10.1001/jamaoto.2018.4513 [doi]
PST - ppublish
SO  - JAMA Otolaryngol Head Neck Surg. 2019 Apr 1;145(4):345-351. doi: 
      10.1001/jamaoto.2018.4513.