Sequelae of Index Complications following Inpatient Head and Neck Surgery: Characterizing Secondary Complications

Alexander N. Goel, Karam W. Badran, Alexander M. Garrett, Maie A. St. John, Jennifer L. Long

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objective: To characterize patterns of secondary complications after inpatient head and neck surgery. Study Design: Retrospective cohort study. Setting: National Surgical Quality Improvement Program (2005-2015). Subjects and Methods: We identified 18,584 patients who underwent inpatient otolaryngologic surgery. Four index complications were studied: pneumonia, bleeding or transfusion event (BTE), deep/organ space surgical site infection (SSI), and myocardial infarction (MI). Each patient with an index complication was matched to a control patient based on propensity for the index event and event-free days. Rates of 30-day secondary complications and mortality were compared. Results: Index pneumonia (n = 254) was associated with several complications, including reintubation (odds ratio [OR], 11.7; 95% confidence interval [CI], 5.2-26.4), sepsis (OR, 8.8; 95% CI, 4.5-17.2), and death (OR, 5.3; 95% CI, 1.9-14.9). Index MI (n = 50) was associated with increased odds of reintubation (OR, 17.2; 95% CI, 3.5-84.1), ventilatory failure (OR, 5.8; 95% CI, 1.8-19.1), and death (OR, 24.8; 95% CI, 2.9-211.4). Index deep/organ space SSI (n = 271) was associated with dehiscence (OR, 7.2; 95% CI, 3.6-14.2) and sepsis (OR, 38.3; 95% CI, 11.6-126.4). Index BTE (n = 1009) increased the odds of cardiac arrest (OR, 3.9; 95% CI, 1.8-8.5) and death (OR, 2.9; 95% CI, 1.6-5.1). Conclusions: Our study is the first to quantify the effect of index complications on the risk of specific secondary complications following inpatient head and neck surgery. These associations may be used to identify patients most at risk postoperatively and target specific interventions aimed to prevent or interrupt further complications.

Original languageEnglish
Pages (from-to)274-282
Number of pages9
JournalOtolaryngology - Head and Neck Surgery
Volume159
Issue number2
DOIs
StatePublished - 1 Aug 2018
Externally publishedYes

Keywords

  • National Surgical Quality Improvement Program
  • complications
  • failure to rescue
  • head and neck

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