Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases
Abstract Background Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to de...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2019-11-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s40463-019-0387-y |
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| author | Cory Donovan Bovenzi Peter Ciolek Meghan Crippen Joseph M. Curry Howard Krein Ryan Heffelfinger |
| author_facet | Cory Donovan Bovenzi Peter Ciolek Meghan Crippen Joseph M. Curry Howard Krein Ryan Heffelfinger |
| author_sort | Cory Donovan Bovenzi |
| collection | DOAJ |
| description | Abstract Background Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy. Methods A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events. Results There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation. Conclusions There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting. |
| format | Article |
| id | doaj-art-0f87c1413bc34b90a69c6c513402e7a7 |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-0f87c1413bc34b90a69c6c513402e7a72025-02-03T10:54:11ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162019-11-014811810.1186/s40463-019-0387-yReconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 casesCory Donovan Bovenzi0Peter Ciolek1Meghan Crippen2Joseph M. Curry3Howard Krein4Ryan Heffelfinger5Thomas Jefferson University Hospital Department of Otolaryngology- Head and Neck SurgeryThomas Jefferson University Hospital Department of Otolaryngology- Head and Neck SurgeryThomas Jefferson University Hospital Department of Otolaryngology- Head and Neck SurgeryThomas Jefferson University Hospital Department of Otolaryngology- Head and Neck SurgeryThomas Jefferson University Hospital Department of Otolaryngology- Head and Neck SurgeryThomas Jefferson University Hospital Department of Otolaryngology- Head and Neck SurgeryAbstract Background Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy. Methods A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events. Results There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation. Conclusions There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.http://link.springer.com/article/10.1186/s40463-019-0387-yParotidectomyComplicationsFacial nerveNSQIPReconstructionEpidemiology |
| spellingShingle | Cory Donovan Bovenzi Peter Ciolek Meghan Crippen Joseph M. Curry Howard Krein Ryan Heffelfinger Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases Journal of Otolaryngology - Head and Neck Surgery Parotidectomy Complications Facial nerve NSQIP Reconstruction Epidemiology |
| title | Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases |
| title_full | Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases |
| title_fullStr | Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases |
| title_full_unstemmed | Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases |
| title_short | Reconstructive trends and complications following parotidectomy: incidence and predictors in 11,057 cases |
| title_sort | reconstructive trends and complications following parotidectomy incidence and predictors in 11 057 cases |
| topic | Parotidectomy Complications Facial nerve NSQIP Reconstruction Epidemiology |
| url | http://link.springer.com/article/10.1186/s40463-019-0387-y |
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