title: Comorbidity as a major risk factor for mortality and complications in head and neck surgery.
abstract: OBJECTIVE
  To describe the impact of comorbidity on complications of surgery and mortality in patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  A total of 120 consecutive patients with HNSCC, treated surgically between January 1999 and December 2001, were included. The Adult Comorbidity Evaluation 27 index (ACE-27) and the American Society of Anesthesiologists (ASA) risk classification system were used to describe comorbidity. Major complications were defined and scored by review of the medical records. Univariate and multivariate analyses were performed to determine the impact of 17 clinical variables, including the ACE-27 grade and the ASA class.
  
  
  RESULTS
  Twenty-five patients (21.4%) had 1 or more major complications. In the univariate analysis, ACE-27 grade, ASA class, T stage, surgical procedure used for the primary tumor, type of neck dissection, and duration of anesthesia had a significant relation with major complications. In the multivariate analysis, duration of anesthesia and comorbidity reflected by the ACE-27 grade or the ASA class remained significant. The odds ratios (95% confidence intervals) associated with ACE-27 grades of 1 and 2 were 1.9 (0.6-6.8) and 4.6 (1.4-15.2), respectively; with ASA classes 2 and 3, 2.0 (0.5-8.2) and 10.0 (2.2-45.1), respectively. Duration of anesthesia longer than 360 minutes was characterized by an odds ratio of 7.8 (1.8-12.9).
  
  
  CONCLUSIONS
  Duration of anesthesia and comorbidity reflected by the ACE-27 grade and the ASA class are important predictors of major complications in head and neck surgery. Optimizing the general condition of patients with HNSCC might reduce morbidity and treatment-related costs.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands. M.B.Ferrier@LUM.nl
authors.forename: Marciano B
authors.initials: MB
authors.lastname: Ferrier
authors.forename: Emiel B
authors.initials: EB
authors.lastname: Spuesens
authors.forename: Saskia
authors.initials: S
authors.lastname: Le Cessie
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Baatenburg de Jong
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012307:Risk Factors