Oropharyngeal Contamination Predisposes to Complications after Neck Dissection: An Analysis of 9462 Patients.
OBJECTIVE
While neck dissection is important in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. We sought to compare preoperative variables and outcomes between clean and contaminated neck dissections, using the 2006-2011 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data sets.


METHODS
Retrospective review of prospectively maintained database.


METHODS
Multicenter (university hospitals; tertiary referral centers).


METHODS
A retrospective review was performed of the NSQIP database to identify patients undergoing neck dissection in clean vs oropharyngeal contaminated cases. Clinical factors, comorbidities, epidemiologic factors, and procedural characteristics were analyzed to identify factors associated with 30-day postoperative adverse events, including medical and surgical complications, unplanned reoperation, and mortality. Bivariate and multivariable analyses were performed for the outcome of one or more adverse events.


RESULTS
In total, 8890 patients had clean neck dissections, while 572 patients had neck wound contamination with oropharyngeal flora. On multivariable regression analysis, oropharyngeal contamination was a significant risk factor for surgical complications (odds ratio [OR], 3.42; 95% confidence interval [CI], 1.96-5.96; P < .001). However, medical complications and mortality were not significantly different between the 2 cohorts. This finding persisted after subgroup analysis, with removal of all thyroidectomy patients from analysis (OR, 2.33; 95% CI, 1.25-4.36; P = .008).


CONCLUSIONS
Using the ACS-NSQIP data set, this study found an increased risk of surgical complications in the setting of contaminated neck dissections. These data should be used for patient risk stratification, informed consent, and to guide further research.
Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Umang
U
Jain
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Jessica
J
Somerville
Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Sujata
S
Saha
Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Nicholas James
NJ
Hackett
Department of Plastic, Reconstructive, and Hand Surgery, Baptist Cancer Center-Vanderbilt Ingram Cancer Center, Memphis, Tennessee, USA jpverhalen@gmail.com.
Jon P
JP
Ver Halen
Division of Plastic and Reconstructive Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Anuja K
AK
Antony
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Sandeep
S
Samant
D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000378:metabolism*; D037981:Neck Dissection / Q000009:adverse effects*; D009960:Oropharynx; D010614:Pharynx / Q000378:metabolism*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*
NSQIP; clean cases; contaminated cases; mortality; neck dissection; outcomes