TY - JOUR
T1 - Sequelae of Index Complications following Inpatient Head and Neck Surgery
T2 - Characterizing Secondary Complications
AU - Goel, Alexander N.
AU - Badran, Karam W.
AU - Garrett, Alexander M.
AU - St. John, Maie A.
AU - Long, Jennifer L.
N1 - Publisher Copyright:
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2018.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - 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.
AB - 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.
KW - National Surgical Quality Improvement Program
KW - complications
KW - failure to rescue
KW - head and neck
UR - http://www.scopus.com/inward/record.url?scp=85045349973&partnerID=8YFLogxK
U2 - 10.1177/0194599818757960
DO - 10.1177/0194599818757960
M3 - Article
C2 - 29406797
AN - SCOPUS:85045349973
SN - 0194-5998
VL - 159
SP - 274
EP - 282
JO - Otolaryngology - Head and Neck Surgery
JF - Otolaryngology - Head and Neck Surgery
IS - 2
ER -