Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2020

01-02-2020 | Hematoma | Head and Neck Oncology

Evaluating Unplanned Returns to the Operating Room in Head and Neck Free Flap Patients

Authors: Samantha Tam, MD, MPH, Randal S. Weber, MD, Jun Liu, PhD, Jose Ting, BS, Summer Hanson, MD, PhD, Carol M. Lewis, MD, MPH

Published in: Annals of Surgical Oncology | Issue 2/2020

Login to get access

Abstract

Background

Head and neck oncologic surgery with reconstruction represents one of the most complex operations in otolaryngology. Unplanned return to the operating room represents an objective measure of postoperative complications. The purpose of this study was to identify reasons and risk factors for unplanned return to the operating room in patients undergoing head and neck surgery with reconstruction.

Methods

This retrospective cohort study of 467 patients undergoing head and neck surgery with free flap reconstruction used a previously-developed Head and Neck-Reconstructive Surgery-specific National Surgical Quality Improvement Program. Disease and site-specific preoperative, intraoperative, and postoperative data were gathered. Comparisons between those with and without an unexpected return to the operating room were completed with univariate and multiple logistic regression models.

Results

The rate of unexpected return to the operating room was 18.8% (88 patients). Most common reasons for URTOR were flap compromise (24 patients, 5.1%), postoperative infection (21 patients, 4.5%), and hematoma (20 patients, 4.3%). Two risk factors were identified by multivariate analysis: coagulopathy (ORadjusted = 2.83, 95% CI = 1.24–6.19, P = 0.010), and use of alcohol (ORadjusted = 1.9, 95% CI = 1.14–3.33, P = 0.025).

Conclusions

Preexisting coagulopathy and increased alcohol consumption were associated with increased risk of unexpected return to the operating room. These findings can aid physicians in preoperative patient counseling and medical optimization and can inform more precise risk stratification of patients undergoing head and neck surgery with reconstruction. Strategies to prevent and mitigate unexpected returns to the operating room will improve patient outcomes, decrease resource utilization, and facilitate successful integration into alternative payment models.
Appendix
Available only for authorised users
Literature
1.
Weber RS, Lewis CM, Eastman SD, et al. Quality and performance indicators in an academic department of head and neck surgery. Arch Otolaryngol Head Neck Surg. 2010;136(12):1212–1218.CrossRef
2.
Lewis CM, Monroe MM, Roberts DB, Hessel AC, Lai SY, Weber RS. An audit and feedback system for effective quality improvement in head and neck surgery: can we become better surgeons? Cancer. 2015;121(10):1581–1587.CrossRef
3.
Khuri SF, Daley J, Henderson W, et al. The national veterans administration surgical risk study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995;180(5):519–531.PubMed
4.
Khuri SF, Daley J, Henderson W, et al. The Department of veterans affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA surgical quality improvement program. Ann Surg. 1998;228(4):491–507.CrossRef
5.
Prasad KG, Nelson BG, Deig CR, et al. ACS NSQIP risk calculator: an accurate predictor of complications in major head and neck surgery? Otolaryngol Head Neck Surg. 2016;155(5):740–742.CrossRef
6.
Schneider AL, Deig CR, Prasad KG, et al. Ability of the national surgical quality improvement program risk calculator to predict complications following total laryngectomy. JAMA Otolaryngol Head Neck Surg. 2016;142(10):972–979.CrossRef
7.
Arce K, Moore EJ, Lohse CM, Reiland MD, Yetzer JG, Ettinger KS. The American college of surgeons national surgical quality improvement program surgical risk calculator does not accurately predict risk of 30-day complications among patients undergoing microvascular head and neck reconstruction. J Oral Maxillofac Surg. 2016;74(9):1850–1858.CrossRef
8.
Bur AM, Brant JA, Mulvey CL, et al. Association of clinical risk factors and postoperative complications with unplanned hospital readmission after head and neck cancer surgery. JAMA Otolaryngol Head Neck Surg. 2016;142(12):1184–1190.CrossRef
9.
Birkmeyer JD, Shahian DM, Dimick JB, et al. Blueprint for a new American college of surgeons: national surgical quality improvement program. J Am Coll Surg. 2008;207(5):777–782.CrossRef
10.
Lewis CM, Aloia TA, Shi W, et al. Development and feasibility of a specialty-specific national surgical quality improvement program (NSQIP): the head and neck-reconstructive surgery NSQIP. JAMA Otolaryngol Head Neck Surg. 2016;142(4):321–327.CrossRef
11.
Halle M, Eriksson BO, Docherty Skogh AC, Sommar P, Hammarstedt L, Gahm C. Improved head and neck free flap outcome-effects of a treatment protocol adjustment from pre- to postoperative radiotherapy. Plast Reconstr Surg Global Open. 2017;5(3):e1253.CrossRef
12.
Benatar MJ, Dassonville O, Chamorey E, et al. Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases. J Plast Reconstr Aesthet Surg. 2013;66(4):478–482.CrossRef
13.
Chen Y, Cao W, Gao X, et al. Predicting postoperative complications of head and neck squamous cell carcinoma in elderly patients using random forest algorithm model. BMC Med Inform Decis Mak. 2015;15:44.CrossRef
14.
Birkmeyer JD, Hamby LS, Birkmeyer CM, Decker MV, Karon NM, Dow RW. Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg (Chicago, Ill: 1960). 2001;136(4):405–411.CrossRef
15.
Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy antithrombotic therapy and prevention of thrombosis, 9th edn: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2):e326S–e350S.CrossRef
16.
Ligh CA, Nelson JA, Wink JD, et al. An analysis of early oncologic head and neck free flap reoperations from the 2005–2012 ACS-NSQIP dataset. J Plast Surg Hand Surg. 2016;50(2):85–92.CrossRef
17.
Cannady SB, Hatten KM, Bur AM, et al. Use of free tissue transfer in head and neck cancer surgery and risk of overall and serious complication(s): an American College Of Surgeons-National Surgical Quality Improvement Project analysis of free tissue transfer to the head and neck. Head Neck. 2017;39(4):702–707.CrossRef
18.
Jung MK, Callaci JJ, Lauing KL, et al. Alcohol exposure and mechanisms of tissue injury and repair. Alcohol Clin Exp Res. 2011;35(3):392–399.CrossRef
19.
Radek KA, Ranzer MJ, DiPietro LA. Brewing complications: the effect of acute ethanol exposure on wound healing. J Leukoc Biol. 2009;86(5):1125–1134.CrossRef
20.
Trevejo-Nunez G, Kolls JK, de Wit M. Alcohol use as a risk factor in infections and healing: a clinician’s perspective. Alcohol Res 2015;37(2):177–184.PubMedPubMedCentral
21.
Eliasen M, Gronkjaer M, Skov-Ettrup LS, et al. Preoperative alcohol consumption and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2013;258(6):930–942.CrossRef
22.
Tonnesen H, Petersen KR, Hojgaard L, et al. Postoperative morbidity among symptom-free alcohol misusers. Lancet (London, Engl). 1992;340(8815):334–337.CrossRef
23.
van Rooijen S, Carli F, Dalton SO, et al. Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation. Acta Oncol. 2017;56(2):329–334.CrossRef
24.
Santoro L, Tagliabue M, Massaro MA, et al. Algorithm to predict postoperative complications in oropharyngeal and oral cavity carcinoma. Head Neck. 2015;37(4):548–556.CrossRef
25.
Shah S, Weed HG, He X, Agrawal A, Ozer E, Schuller DE. Alcohol-related predictors of delirium after major head and neck cancer surgery. Arch Otolaryngol Head Neck Surg. 2012;138(3):266–271.CrossRef
26.
Gueret G, Bourgain JL, Luboinski B. Sudden death after major head and neck surgery. Current. 2006;14(2):89–94.
27.
BuSaba NY, Schaumberg DA. Predictors of prolonged length of stay after major elective head and neck surgery. Laryngoscope. 2007;117(10):1756–1763.CrossRef
28.
Tonnesen H, Rosenberg J, Nielsen HJ, et al. Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial. BMJ (Clin Res ed). 1999;318(7194):1311–1316.CrossRef
29.
Tonnesen H, Nielsen PR, Lauritzen JB, et al. Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth. 2009;102(3):297–306.CrossRef
30.
Asher SA, White HN, Kejner AE, Rosenthal EL, Carroll WR, Magnuson JS. Hemorrhage after transoral robotic-assisted surgery. Otolaryngol Head Neck Surg. 2013;149(1):112–117.CrossRef
31.
Kraft CT, Bellile E, Baker SR, et al. Anticoagulant complications in facial plastic and reconstructive surgery. JAMA Facial Plast Surg. 2015;17(2):103–107.CrossRef
32.
Urken ML, Weinberg H, Buchbinder D, et al. Microvascular free flaps in head and neck reconstruction Report of 200 cases and review of complications. Arch Otolaryngol Head Neck Surg. 1994;120(6):633–640.CrossRef
33.
Blackwell KE. Unsurpassed reliability of free flaps for head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 1999;125(3):295–299.CrossRef
34.
Corbitt C, Skoracki RJ, Yu P, Hanasono MM. Free flap failure in head and neck reconstruction. Head Neck. 2014;36(10):1440–1445.PubMed
35.
Clemens MW, Hanson SE, Rao S, Truong A, Liu J, Yu P. Rapid awakening protocol in complex head and neck reconstruction. Head Neck. 2015;37(4):464–470.CrossRef
Metadata
Title
Evaluating Unplanned Returns to the Operating Room in Head and Neck Free Flap Patients
Authors
Samantha Tam, MD, MPH
Randal S. Weber, MD
Jun Liu, PhD
Jose Ting, BS
Summer Hanson, MD, PhD
Carol M. Lewis, MD, MPH
Publication date
01-02-2020
Publisher
Springer International Publishing
Keyword
Hematoma
Published in
Annals of Surgical Oncology / Issue 2/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07675-3

Other articles of this Issue 2/2020

Annals of Surgical Oncology 2/2020 Go to the issue

ASO Author Reflections

ASO Author Reflections: Key Challenges in Expanding the Utilization of Nipple-Sparing Mastectomy

ASO Author Reflections

ASO Author Reflections: Do Advances in Neoadjuvant Therapy Influence How We Surgically Manage the Regional Lymphatics in Gastric Cancer?

Reconstructive Oncology

Invited Editorial: “The Head and Neck Reconstructive Surgery National Surgical Quality Improvement Program (NSQIP): Evaluating Unplanned Returns to the Operating Room” by Tam S et al.

ASO Author Reflections

ASO Author Reflections: More May Not Be Better

Thoracic Oncology

Clinical T4b Esophageal Cancer: Can We Make an “Unresectable” Tumour Resectable?

ASO Author Reflections

ASO Author Reflections: Systematic Mesogastric Excision as a Universal Concept in Gastric Cancer Surgery