title: A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics-based Outcomes Surveillance Framework.
abstract: OBJECTIVE
  To perform a national analysis of the perioperative outcome of major head and neck cancer surgery to develop a stratification strategy and outcomes assessment framework using hospital administrative data.
  
  
  METHODS
  A Hospital Episode Statistics N = near-all analysis.
  
  
  METHODS
  The English National Health Service.
  
  
  METHODS
  Local audit data were used to assess and triangulate the quality of the administrative dataset. Within the national dataset, cancer sites, morbidities, social deprivation, treatment, complications, and in-hospital mortality were recorded.
  
  
  RESULTS
  Within local audit datasets, the accuracy of assigning newly-derived Cancer Site Strata and Resection Strata were 92.3% and 94.2%, respectively. Accuracy of morbidities assignment was 97%. Within the national dataset, we identified 17 623 major head and neck cancer resections between 2002 and 2012. There were 12 413 males and mean age at surgery was 63 ± 12 years. The commonest cancer site strata were oral cavity (42%) and larynx-hypopharynx (32%). The commonest resection site was the larynx (n = 4217), and 13 211 and 11 841 patients had neck dissection and flap-based reconstruction, respectively. There were prognostically significant baseline differences between patients with oromandibular and pharyngolaryngeal malignancy. Patients with pharyngolaryngeal malignancies had a greater burden of morbidities, lower socio-economic status, fewer primary resections, and a sixfold increased risk of undergoing their major resection during an emergency hospital admission. Mean length of stay was 25 days and each complication linearly increased it by 9.6 days. There were 609 (3.5%) in-hospital deaths and a basket of seven medical and three surgical complications significantly increased the risk of in-hospital death. At least one potentially lethal complication occurred in 26% of patients. The risk of in-hospital death in a patient with no potentially lethal complication was 1.1% and this increased to 6% with one potentially lethal complication, and to 15.1% if two potentially lethal complications occurred in one patient. Complex oral-pharyngeal resections and pharyngolaryngectomies had the highest risks of complications and mortality.
  
  
  CONCLUSIONS
  Mortality following head and neck cancer surgery shows variation across different resection strata. We propose an Informatics-based Framework for Outcomes Surveillance (IFOS) in Head and Neck Surgery for perpetual quality assurance, using the local hospital coding data or its collated destination, the national administrative dataset.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery Surgery, University College Hospital NHS Foundation Trust, London, UK.|National Institute of Health and Care Excellence (NICE) 2013 Scholar, London, UK.|The Ear Institute, University College London, London, UK.
authors.forename: S A R
authors.initials: SA
authors.lastname: Nouraei
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Mace
authors.affiliation: Dr Foster Intelligence Ltd, London, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Middleton
authors.affiliation: Department of Clinical Coding, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hudovsky
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery Surgery, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Vaz
authors.affiliation: Department of Oral & Maxillofacial Surgery, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Moss
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Barts Health, Royal London Hospital, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ghufoor
authors.affiliation: Department of Clinical Oncology, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Mendes
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery Surgery, University College Hospital NHS Foundation Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: O'Flynn
authors.affiliation: Department of Plastic & Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Jallali
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Clarke
authors.affiliation: Academic Surgical Unit, Department of Surgery & Cancer, St Mary's Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Dr Foster Unit at Imperial College, Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Aylin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004739:England / Q000453:epidemiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008490:Medical Informatics; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures; D013997:Time Factors; D055815:Young Adult