Table 3 - uploaded by Nebu Abraham George
Content may be subject to copyright.
Source publication
The purpose of the study was to construct and validate a risk model to predict morbidity in head and neck oncosurgeries. Potential risk factors of 300 surgically treated head and neck cancer patients like age, sex, tumor site, TNM stage, duration of surgery, adjunctive treatment, comorbidities and alcohol and tobacco usage were analyzed. Postoperat...
Context in source publication
Context 1
... incidence of major postoperative medical complications was 14.4% and surgical complications were 14.8%. The frequencies of postoperative problems are listed in Table 3. The commonest postoperative surgical problem was flap necrosis (4.4%) and common- est systemic problem was pneumonia (2.4%) ...
Citations
... 8 Their judicious use could minimize rates of failure to rescue (or mortality after a major complication), improve morbidity rates, and ultimately enhance quality of care in head and neck oncologic surgery. 18 Comparisons with other studies 1,6,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] in the literature are hampered by variability of tumor site in the head and neck region, sample size, and the surgical procedure performed (ablative or reconstructive), as well as whether or not multimodal treatment was included. Equally important is the pervasive inconsistency in the definition of complications across such studies. ...
Importance
Postoperative complications after head and neck surgery carry the potential for significant morbidity. Estimating the risk of complications in an individual patient is challenging.Objective
To develop a statistical tool capable of predicting an individual patient’s risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.Design, Setting, and Participants
Retrospective case series derived from an institutional clinical oncologic database, augmented by medical record abstraction, at an academic tertiary care cancer center. Participants were 506 previously untreated adult patients with biopsy-proven oral cavity squamous cell carcinoma who underwent surgery between January 1, 2007, and December 31, 2012.Main Outcomes and Measures
The primary end point was a major postoperative complication requiring invasive intervention (Clavien-Dindo classification grades III-V). Patients treated between January 1, 2007, and December 31, 2008 (354 of 506 [70.0%]) comprised the modeling cohort and were used to develop a nomogram to predict the risk of developing the primary end point. Univariable analysis and correlation analysis were used to prescreen 36 potential predictors for incorporation in the subsequent multivariable logistic regression analysis. The variables with the highest predictive value were identified with the step-down model reduction method and included in the nomogram. Patients treated between January 1, 2007, and December 31, 2008 (152 of 506 [30.0%]) were used to validate the nomogram.Results
Clinical characteristics were similar between the 2 cohorts for most comparisons. Thirty-six patients in the modeling cohort (10.2%) and 16 patients in the validation cohort (10.5%) developed a major postoperative complication. The 6 preoperative variables with the highest individual predictive value were incorporated within the nomogram, including body mass index, comorbidity status, preoperative white blood cell count, preoperative hematocrit, planned neck dissection, and planned tracheotomy. The nomogram predicted a major complication with a validated concordance index of 0.79. Inclusion of surgical operative variables in the nomogram maintained predictive accuracy (concordance index, 0.77).Conclusions and Relevance
A statistical tool was developed that accurately estimates an individual patient’s risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.
... In these settings one has to make decisions considering all data in individual case. Thomas et al. tried to create a model to predict morbidities for head and neck cancer patients [36]. Based on their data preliminary radiation therapy, high blood pressure and in particular prolonged surgery time were predicting factors for higher morbidity. ...
Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice.
To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur.
Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.
