title: Analysis of morbidity and mortality in patients undergoing skull base reconstruction.
abstract: The relative rarity of skull base tumors has limited surgeons' ability to report on morbidity and mortality in a large and nationwide patient series. We aimed to assess the impact of reconstructive procedures on patients undergoing skull base surgery and to determine whether 30-day postoperative morbidity and mortality varied between patients who underwent reconstruction and those who did not. We performed a retrospective analysis using American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012 databases. Chi-squared tests were used for categorical variables and t-tests were used for continuous variables. Multiple logistic regression analysis predicted the influence of preoperative and operative variables on complications. A total of 479 patients were included in our study; 199 patients received concurrent reconstruction. There was no statistically significant difference in wound complication, morbidity, length of total hospital stay, and mortality between the 2 groups. The reconstruction cohort showed significantly longer operative times (416.45 [207.585] versus 319.99 [222.813] min, P = 0.001) and higher return to the operating room rate (13.6% versus 6.1%, P = 0.005). Reconstruction using pedicled flaps was associated with increased odds of wound complications (odds ratio, 4.937; P = 0.023), and microsurgical reconstruction was associated with return to the operating room (odds ratio, 2.212; P = 0.015). According to logistic regression, dyspnea, diabetes mellitus, functional status, and tumor involving the central nervous system were associated with complications. This study is the first comprehensive analysis of reconstruction after skull base surgery. Additional measures involved in flap reconstruction are associated with an increase in operation time and return to the operating room rate but not with complications, morbidity, or mortality.
authors.affiliation: From the *Division of Plastic Surgery, and †Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and ‡Medical University of Vienna, Vienna, Austria.
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: Nargiz
authors.initials: N
authors.lastname: Seyidova
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D016009:Chi-Square Distribution; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D058752:Free Tissue Flaps / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008866:Microsurgery / Q000706:statistics & numerical data; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality*; D016634:Radiosurgery / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000401:mortality*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery; D013524:Surgical Flaps; D015996:Survival Rate