颞骨切除术和颈部切除术患者并发症的风险因素:来自全国数据库的启示

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY
Liam M Ordoyne, Ivan Alvarez, Grant Borne, Isabella Fabian, Dauren Adilbay, Rema A Kandula, Ameya A Asarkar, Cherie-Ann O Nathan, Lindsay Olinde, John Pang
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引用次数: 0

摘要

背景:对于有隐匿性或临床颈淋巴结转移的耳科恶性肿瘤,可进行颞骨切除术(TBR),同时进行或不进行颈部清扫术(ND)。迄今为止,单个机构病例系列中术后并发症的特征可能无法代表真实世界的结果。在此,我们利用全国住院病人抽样调查(NIS)的数据来全面评估所遇到的并发症及其发生频率,并找出潜在的风险因素,以改善未来的治疗效果:研究对象为 2017 年至 2019 年期间从 NIS 中获得的接受 TBR 和 ND 治疗的患者。我们利用 ICD-10 诊断代码来识别术后并发症患者、出院到非家庭设施(DNHF)的患者以及住院时间(LOS)延长的患者。为了确定与上述结果相关的重要变量,我们进行了多变量回归:在277名接受LTBR和ND的患者中,有90人出现了术后并发症。伤口并发症是最常见的并发症,有11例(4%)患者出现伤口并发症,其次是脑脊液漏(6例;2.2%),急性呼吸衰竭是最常见的内科并发症(4例;1.4%)。16%的患者(45/277)出院后被送往家庭以外的机构。痴呆(OR = 7.96;CI95 3.62-17.48)、贫血(OR = 2.39;CI95 1.15-4.99)、充血性心力衰竭(OR = 5.31;CI95 1.82-15.45)、慢性阻塞性肺病(OR = 3.70;CI95 1.35-10.16)和既往中风史(OR = 8.50;CI95 1.55-46.68)增加了 DNHF 的几率。在评估LOS(中位数=5天,IQR=1-9)时,发现贫血(OR=5.49;CI95为2.86-10.52)和医疗补助保险(OR=3.07;CI95为1.06-10.52)会增加LOS:结论:绝大多数接受LTBR治疗的玖玖彩票网正规吗患者没有并发症,并在一周内出院。肝脏疾病是导致医疗并发症和费用增加的风险因素。该研究发现了与接受颞骨切除术和颈部解剖术的患者术后预后较差有关的因素。尽管对大多数患者来说都是安全的,但已确诊肝病、中风、痴呆和贫血的患者有发生不良后果的风险:3.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk Factors for Complications in Patients Undergoing Temporal Bone Resection and Neck Dissection: Insights From a National Database.

Background: Temporal bone resection (TBR) with or without neck dissection (ND) is performed for otologic malignancies with occult or clinical cervical lymph node metastases. To date, characterization of post-operative complications in single institution case series may be non-representative of real-world outcomes. Here, we used data from the National Inpatient Sample (NIS) to comprehensively assess the complications encountered, their frequencies, and to identify underlying risk factors to improve future outcomes.

Methods: The population was patients undergoing TBR and ND derived from the NIS between the years of 2017 and 2019. We utilized ICD-10 diagnosis codes to identify patients with post-operative complications, those discharged to non-home facilities (DNHF), and those with increased length of stay (LOS). Multivariable regression was performed to identify significant variables related to the above outcomes.

Results: Ninety of 277 patients that underwent LTBR with ND had postoperative complications. Wound complications were the most frequent complication, occurring in 11 (4%) of patients, followed by CSF leak (n = 6; 2.2%), with acute respiratory failure being the most common medical complication (n = 4; 1.4%). Sixteen percent (45/277) were discharged to a facility besides home. Dementia (OR = 7.96; CI95 3.62-17.48), anemia (OR = 2.39; CI95 1.15-4.99), congestive heart failure (OR = 5.31; CI95 1.82-15.45), COPD (OR = 3.70; CI95 1.35-10.16), and history of prior stroke (OR = 8.50; CI95 1.55-46.68) increased the odds of DNHF. When evaluating LOS (median = 5 days, IQR = 1, 9), anemia (OR = 5.49; CI95 2.86-10.52), and Medicaid insurance (OR = 3.07; CI95 1.06-10.52) were found to increase the LOS.

Conclusions: The vast majority of patients undergoing LTBR with ND have no complications and are discharged within a week. Liver disease is a risk factor for medical complications and increased charges. Patients with dementia or a prior stroke are at risk for DNHF, and those with prior anemia are at risk for a wound complication.

Lay summary: This study identified factors related to worse post-operative outcomes in patients undergoing temporal bone resection and neck dissection. Although safe for most patients, an existing diagnosis of liver disease, stroke, dementia, and anemia specifically are at risk for developing negative outcomes.

Level of evidence: 3.

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来源期刊
CiteScore
3.10
自引率
7.10%
发文量
171
审稿时长
4-8 weeks
期刊介绍: The Annals of Otology, Rhinology & Laryngology publishes original manuscripts of clinical and research importance in otolaryngology–head and neck medicine and surgery, otology, neurotology, bronchoesophagology, laryngology, rhinology, head and neck oncology and surgery, plastic and reconstructive surgery, pediatric otolaryngology, audiology, and speech pathology. In-depth studies (supplements), papers of historical interest, and reviews of computer software and applications in otolaryngology are also published, as well as imaging, pathology, and clinicopathology studies, book reviews, and letters to the editor. AOR is the official journal of the American Broncho-Esophagological Association.
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