Score system for elective tracheotomy in major head and neck tumour surgery.
BACKGROUND
This study was designed to evaluate prognostic parameters for respiratory failure after major oropharyngeal resections in head and neck cancer surgery, focusing on a score system to identify patients requiring an elective tracheotomy and to avoid tracheotomy under emergency conditions.


METHODS
One hundred and fifty-two out of 928 patients with oropharyngeal cancers, treated between January 1993 and June 2000 at our hospital, fulfilled the inclusion criteria for a retrospective analysis. This collective underwent tumour resection in different regions of the oropharynx combined with bony resection of the mandible and neck dissection without primary tracheotomy. The reconstruction was accomplished using radial forearm flaps (n1 = 59) or local flaps (n2 = 93). These two groups were subdivided into patients treated post-operatively by tracheotomy due to respiratory failure (n1 = 26; n2 = 12) and those without such treatment (n1 = 33; n2 = 81). The database comprising tumour localization and size, staging, general medical condition, smoking and alcohol consumption was evaluated by logistic regression.


RESULTS
We developed a score system which predicts the likelihood of post-operative respiratory failure. For indication of tracheotomy, tumour size and localization, multimorbidity, alcohol consumption and pathologic chest X-ray findings were identified as significant parameters with different weightings. The predictive value for tracheotomy (yes/no) using the score system was 96.7% for the total collective.


CONCLUSIONS
The decision on whether or not an elective tracheotomy in major head and neck tumour surgery is necessary can be facilitated using this score system which is based on objective facts. It may reduce post-operative complications and contribute to safer treatment.
Kruse-Lösler
B
B
Clinics for Cranio-Maxillofacial Surgery, University of Münster, Waldeyerstrasse 30, 48129 Münster, Germany. losler@uni-muenster.de
Langer
E
E
Reich
A
A
Joos
U
U
Kleinheinz
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D017558:Elective Surgical Procedures; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000601:surgery; D009960:Oropharynx / Q000601:surgery; D011379:Prognosis; D011859:Radiography; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D014140:Tracheotomy