A stratified analysis of the perioperative outcome of 17,623 patients undergoing major head and neck cancer surgery in England over 10 years.

A stratified analysis of the perioperative outcome of 17,623 patients undergoing major head and neck cancer surgery in England over 10 years.

Clin Otolaryngol. 2016 Mar 15;

Authors: Nouraei S, Mace AD, Middleton SE, Hudovsky A, Vaz F, Moss C, Ghufoor K, Mendes R, O'Flynn P, Jallali N, Clarke PM, Darzi A, Aylin P

Abstract
OBJECTIVES: To perform a national analysis of the perioperative outcome of major head and neck cancer surgery to develop a stratification strategy and outcomes assessment framework using hospital administrative data.
DESIGN: A Hospital Episode Statistics N=near-all analysis.
SETTINGS: The English National Health Service.
MAIN OUTCOME MEASURES: Local audit data were used to assess health informatics data quality. Within the national dataset, cancer sites, morbidities, social deprivation, treatment, complications, and in-hospital mortality were recorded.
RESULTS: Within local audit datasets, the accuracy of assigning cancer site and resection type were 92.3% and 94.2% respectively. Accuracy of morbidities assignment was 97%. Within the national dataset, we identified 17,623 cases between 2003-2012. There were 12,413 males and mean age at surgery was 63±12 years. The commonest cancer site strata were oral cavity (42%) and larynx-hypopharynx (32%). The commonest resection site was the larynx (n=4,217), and 13,211 and 11,841 patients had neck dissection and flap-based reconstruction respectively. There were prognostically-significant baseline differences between patients with oromandibular and pharyngolaryngeal malignancy. Patients with pharyngolaryngeal malignancies had more morbidities, lower socio-economic status, fewer primary resections, and a 6-fold increased risk of undergoing emergency major surgery. Mean length of stay was 25 days and each complication increased it by 9.6 days. There were 609 (3.5%) in-hospital deaths and a basket of 7 medical and 3 surgical complications were prognostic. At least one potentially-lethal complication occurred in 26% of patients. The risk of in-hospital death in a patient with no potentially-lethal complication was 1.1% and this increased to 6% with one potentially-lethal complication and to 15.1% if two potentially-lethal complications occurred in one patient. Complex oral-pharyngeal resections and pharyngolaryngectomies had the highest risks of complications and mortality.
CONCLUSION: Mortality following head and neck cancer surgery shows variation across different resection strata. We propose an Informatics-based Framework for Outcomes Surveillance (IFOS) in Head and Neck Surgery for perpetual quality assurance, using the local hospital coding data or its collated destination, the national administrative dataset. This article is protected by copyright. All rights reserved.

PMID: 26990866 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1VmJEi7
via IFTTT