title: Individualized Risk Estimation for Postoperative Complications After Surgery for Oral Cavity Cancer.
abstract: OBJECTIVE
  Postoperative complications after head and neck surgery carry the potential for significant morbidity. Estimating the risk of complications in an individual patient is challenging.
  
  
  OBJECTIVE
  To develop a statistical tool capable of predicting an individual patient's risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.
  
  
  METHODS
  Retrospective case series derived from an institutional clinical oncologic database, augmented by medical record abstraction, at an academic tertiary care cancer center. Participants were 506 previously untreated adult patients with biopsy-proven oral cavity squamous cell carcinoma who underwent surgery between January 1, 2007, and December 31, 2012.
  
  
  METHODS
  The primary end point was a major postoperative complication requiring invasive intervention (Clavien-Dindo classification grades III-V). Patients treated between January 1, 2007, and December 31, 2008 (354 of 506 [70.0%]) comprised the modeling cohort and were used to develop a nomogram to predict the risk of developing the primary end point. Univariable analysis and correlation analysis were used to prescreen 36 potential predictors for incorporation in the subsequent multivariable logistic regression analysis. The variables with the highest predictive value were identified with the step-down model reduction method and included in the nomogram. Patients treated between January 1, 2007, and December 31, 2008 (152 of 506 [30.0%]) were used to validate the nomogram.
  
  
  RESULTS
  Clinical characteristics were similar between the 2 cohorts for most comparisons. Thirty-six patients in the modeling cohort (10.2%) and 16 patients in the validation cohort (10.5%) developed a major postoperative complication. The 6 preoperative variables with the highest individual predictive value were incorporated within the nomogram, including body mass index, comorbidity status, preoperative white blood cell count, preoperative hematocrit, planned neck dissection, and planned tracheotomy. The nomogram predicted a major complication with a validated concordance index of 0.79. Inclusion of surgical operative variables in the nomogram maintained predictive accuracy (concordance index, 0.77).
  
  
  CONCLUSIONS
  A statistical tool was developed that accurately estimates an individual patient's risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Mahmoud I
authors.initials: MI
authors.lastname: Awad
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Palmer
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lei
authors.initials: L
authors.lastname: Kou
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Pablo H
authors.initials: PH
authors.lastname: Montero
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shuman
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.affiliation: Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006400:Hematocrit; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000009:adverse effects; D009518:New York; D049451:Nomograms; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014140:Tracheotomy / Q000009:adverse effects