title: Analysis of the NSQIP database in 676 patients undergoing laryngopharyngectomy: the impact of flap reconstruction.
abstract: OBJECTIVE
  Assess impact of reconstructive procedures on patients undergoing laryngopharyngectomy and to determine whether 30-day postoperative morbidity and mortality varied between patients who underwent flap reconstruction and those who did not.
  
  
  METHODS
  Retrospective analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  We reviewed the 2005-2011 ACS-NSQIP database to identify patients undergoing laryngectomy and/or pharyngectomy. Bivariate analysis was done to compare preoperative variables and postoperative outcomes between the flap reconstruction group and non-reconstruction group. Chi-square tests were used for categorical variables and t-tests for continuous variables. Logistic regression analysis was performed to calculate odds ratio to account for potential confounders. To create a valid logistic analysis model, F-test was used to determine whether certain variables should be included in the model.
  
  
  RESULTS
  Six hundred seventy-six patients were included in our study; 213 patients received concurrent flap reconstruction whereas 463 did not. After risk adjustment, analyses revealed no statistically significant difference in wound complication, minor morbidity, and mortality between the 2 groups. The flap reconstruction cohort showed significantly longer operative times (8.09 ± 3.36 hours vs 5.63 ± 3.47 hours; P = .001) and higher major morbidity rate (OR = 5.906, 95% CI, 3.131-11.139, P = .001).
  
  
  CONCLUSIONS
  This is the first comprehensive analysis of flap reconstruction for laryngopharyngeal defects using the ACS-NSQIP registry. Additional measures involved in flap reconstruction are associated with an increase in major morbidity but not mortality. An understanding of these variables may optimize the decision-making process for patients undergoing laryngectomy and/or pharyngectomy.
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kuylhee
authors.initials: K
authors.lastname: Kim
authors.forename: Ahmed M S
authors.initials: AM
authors.lastname: Ibrahim
authors.forename: Pieter G L
authors.initials: PG
authors.lastname: Koolen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Frankenthaler
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000379:methods* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010611:Pharyngectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: NSQIP; laryngeal cancer; laryngectomy; laryngopharyngeal defect; laryngopharyngectomy