Subscribe to RSS
DOI: 10.1055/s-0039-1688711
Head and Neck Reconstruction: Does Surgical Specialty Affect Complication Rates?
Publication History
26 November 2018
04 March 2019
Publication Date:
08 May 2019 (online)
Abstract
Background Reconstruction of head and neck defects resulting from resection of head and neck masses is performed by both plastic surgeons and otolaryngologists. The American College of Surgeons National Surgical Quality Improvement (NSQIP) database allows one to directly compare the outcomes for a given procedure based upon specialty. The purpose of this study is to compare outcomes and resource utilization of microvascular head and neck reconstruction between plastic surgery and otolaryngology.
Methods Institutional review board approval was obtained and NSQIP was queried from 2005 to 2015 with inclusion of Current Procedural Terminology codes for free tissue transfer performed for head and neck reconstruction. Outcomes were compared between cases having otolaryngology and plastic surgery as performing the free flap reconstruction.
Results During 2005 to 2015, a total of 2,322 flaps were performed, 893 by plastic surgery and 1,429 by otolaryngology. Average length of stay (LOS) was 13.7 and 11.4 days for plastic surgery and otolaryngology, respectively. It was found that plastic surgery performed more osteocutaneous flaps than otolaryngology. Higher rates of superficial surgical site infection, deep surgical site infections, wound dehiscence, myocardial infarction, bleeding complications, sepsis, unplanned return to the operating room, and unplanned readmission were observed for patients treated by otolaryngology (p < 0.05).
Conclusion This study shows plastic surgery patients have superior outcomes with regards to free tissue transfers of the head and neck when compared with otolaryngology patients. Although plastic surgery patients experienced a longer LOS, the significantly lower complication rate supports an overall more optimal resource utilization. Future studies may elucidate potential cost savings in patients treated by plastic surgery.
Note
This study was presented at the Plastic Surgery Meeting (ASPS) 2017 in Orlando, FL.
-
References
- 1 Edgerton Jr MT. Replacement of lining to oral cavity following surgery. Cancer 1951; 4 (01) 110-119
- 2 Kroll SS, Schusterman MA, Reece GP. , et al. Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg 1996; 98 (07) 1230-1233
- 3 Lodders JN, Parmar S, Stienen NL. , et al. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction. Med Oral Patol Oral Cir Bucal 2015; 20 (06) e744-e750
- 4 Offodile II AC, Aherrera AS, Wenger J, Tsai T, Orgill DP, Guo L. Impact of specialty training on the association between flap size and incidence of complications following microvascular head and neck reconstruction for cancer. J Reconstr Microsurg 2015; 31 (05) 348-354
- 5 Spiegel JH, Polat JK. Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope 2007; 117 (03) 485-490
- 6 Butala P. , Cheung MC, Wilk A, Anolik RA, Hollenbeck ST. Comparison of early outcomes between plastic surgeons and otolaryngologists performing head and neck free flap reconstruction: based on the American College of Surgeons National Surgical Quality Improvement Program. Plast Reconstr Surg 2014; 133 (4S): 989-990
- 7 Kordahi AM, Hoppe IC, Lee ES. A comparison of free tissue transfers to the head and neck performed by surgeons and otolaryngologists. J Craniofac Surg 2016; 27 (01) e82-e85
- 8 Operative Minimums Effective July 1, 2014. Review Committee for Plastic Surgery. Available at: http://www.acgme.org/Portals/0/PFAssets/ProgramResources/Operative_Minimums_effective_07012014.pdf?ver=2017-07-10-102733-190 . Accessed November 5, 2017
- 9 Required Minimum Number of Key Indicator Procedures for Graduating Residents Review Committee for Otolaryngology. Retrieved from Required Minimum Number of Key Indicator Procedures for Graduating Residents Review Committee for Otolaryngology; 2016
- 10 Gendron KM, Lai SY, Weinstein GS. , et al. Clinical care pathway for head and neck cancer: a valuable tool for decreasing resource utilization. Arch Otolaryngol Head Neck Surg 2002; 128 (03) 258-262
- 11 Verrier ED. Who moved my heart? Adaptive responses to disruptive challenges. J Thorac Cardiovasc Surg 2004; 127 (05) 1235-1244
- 12 NSQIP, A. User guide for the 2012 ACS NSQIP participant use data file; 2016