Research Article
BibTex RIS Cite

Overview of the factors affecting outcomes of major head and neck surgery patients discharged to post-anesthesia care unit: 6-year retrospective analysis

Year 2022, Volume: 13 Issue: 47, 259 - 266, 15.12.2022
https://doi.org/10.17944/mkutfd.983464

Abstract

Objective: In this study, it is aimed to determine the factors affecting the postoperative results by retrospectively examining the data of patients who had undergone major head and neck surgery were followed up in the post-anesthesia critical care unit (PACU).

Method: Demographic characteristics, comorbidities, preoperative laboratory findings, surgical characteristics, intraoperative characteristics, postoperative follow-up findings, complications, length of stay (LOS), morbidity data of patients who underwent major head and neck surgery and were followed up in PACU were analyzed.

Results: A total of 74 major head and neck surgery cases were included in this study. A statistically significant relationship was found between preoperative sodium levels, intraoperative blood transfusion and mechanical ventilation (MV) time. It was determined that there was a relationship between PACU LOS and preoperative albumin and sodium level, neutrophil-lymphocyte ratios, blood transfusion and MV duration. A statistically significant relationship was found between the development of the need for intensive care and preoperative sodium levels, operation time, blood transfusion, MV duration, and PACU LOS. A statistically significant relationship is observed between mortality and PACU LOS and need for intensive care.

Conclusion: It has been determined that preoperative electrolyte disturbances, neutrophil-lymphocyte ratios, operation time, intraoperative blood transfusion and mechanical ventilation time are among the factors that affect postoperative results in major head and neck surgery patients.

References

  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/ caac.21492
  • Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019 (US statistics). CA Cancer J Clin. 2019;69(1):7-34. https://doi.org/10.3322/ caac.21551
  • Nouraei SAR, Mace AD, Middleton SE, Hudovsky A, Vaz F, Moss C et al. 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. Clin Otolaryngol. 2017;42(1):11-28. https://doi.org/10.1111/coa.12649
  • Charters P, Ahmad I, Patel A, Russell S. Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(2):23-27. https://doi.org/10.1017/s0022215116000384
  • O’Dell K. Predictors of difficult intubation and the otolaryngology perioperative consult. Anesthesiol Clin. 2015;33(2):279-290. https://doi.org/10.1016/j.anclin.2015.02.002
  • Robson A, Sturman J, Williamson P, Conboy P, Penney S, Wood H. Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(2):13-22. https://doi.org/10.1017/s0022215116000372
  • Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG et al. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013 Feb;118(2):251-70. https://doi.org/10.1097/ALN.0b013e31827773b2.
  • Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77(2):217-222. https://doi.org/10.1093/ bja/77.2.217
  • Godden DRP, Patel M, Baldwin A, Woodwards RTM. Need for intensive care after operations for head and neck cancer surgery. Br J Oral Maxillofac Surg. 1999;37(6):502-505. https://doi. org/10.1054/bjom.1999.0194
  • Arshad H, Ozer HG, Thatcher A, Old M, Ozer E, Agarwal A, et al. Intensive care unit versus non-intensive care unit postoperative management of head and neck free flaps: comparative effectiveness and cost comparisons. Head Neck. 2014;36(10):536- 539. https://doi.org/10.1002/hed.23325
  • İnal DG, Omur D, Hancı V. Postanestezi̇k bakim üni̇tesi̇ (pabü): gelişimi ve standartlari. 2016;56(3):191-196
  • Strauss M, Bellian K. Otolaryngology care unit: a safe and cost-reducing way to deliver quality care. Laryngoscope. 1999;109(9):1428-1432. https://doi.org/10.1097/00005537- 199909000-00013
  • American Society of Anesthesiologists committee of origin: standards and practice parameters. Standards for Postanesthesia Care; 2014. (https://www.asahq.org/standards-and-guidelines/ standards-for-postanesthesia-care)
  • Fakhry C, Lacchetti C, Rooper LM, Jordan RC, Rischin D, Sturgis EM et al. Human papillomavirus testing in head and neck carcinomas: ASCO clinical practice guideline endorsement of the college of American pathologists guideline. J Clin Oncol. 2018;36(31):3152-3161. https://doi.org/10.1200/JCO.18.00684
  • Petrar S, Bartlett C, Hart RD, MacDougall P. Pulmonary complications after major head and neck surgery: A retrospective cohort study. Laryngoscope. 2012;122(5):1057-1061. https://doi.org/10.1002/lary.23228
  • Boruk M, Chernobilsky B, Rosenfeld RM, Har-El G. Age as a prognostic factor for complications of major head and neck surgery. Arch Otolaryngol - Head Neck Surg. 2005;131(7):605-609. https://doi.org/10.1001/archotol.131.7.605
  • Eytan DF, Blackford AL, Eisele DW, Fakhry C. Prevalence of comorbidities and effect on survival in survivors of human papillomavirus-related and human papillomavirus unrelated head and neck cancer in the United States. Cancer. 2019;125(2):249-260. https://doi.org/10.1002/cncr.31800
  • Meerwein C, Pézier TF, Beck-Schimmer B, Schmid S, Huber GF. Airway management in head and neck cancer patients undergoing microvascular free tissue transfer: Delayed extubation as an alternative to routine tracheotomy. Swiss Med Wkly. 2014;144(March):1-8. https://doi.org/10.4414/smw.2014.13941
  • Kipps AK , Wypij D, Thiagarajan RR, Bacha EA, Newburger JW. Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery. Pediatr Crit Care Med. 2011 January ; 12(1): 52-56. https://doi.org/10.1097/PCC.0b013e3181e30d43.BLOOD
  • Nguyen A, Shin H, Saint-Cyr M, Verheyden C. Blood loss and transfusion rates in microsurgical head and neck reconstruction. Plast Reconstr Surg - Glob Open. 2018;6(11):1-4. https://doi.org/10.1097/GOX.0000000000001988
  • Szakmany T, Dodd M, Dempsey GA, Lowe D, Brown JS, Vaughan ED et al. The influence of allogenic blood transfusion in patients having free-flap primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Cancer. 2006;94(5):647-653. https://doi.org/10.1038/sj.bjc.6603013
  • Sakr Y, Lobo S, Knuepfer S, Esser E, Bauer M, Settmacher U et al. Anemia and blood transfusion in a surgical intensive care unit. Crit Care. 2010;14(3). https://doi.org/10.1186/cc9026
  • Puram SV., Yarlagadda BB, Sethi R, Muralidhar V, Chambers KJ, Emerick KS et al. Transfusion in Head and Neck Free Flap Patients: Practice Patterns and a Comparative Analysis by Flap Type. Otolaryngol Neck Surg. 2015;152(3):449-457. https://doi. org/10.1177/0194599814567107
  • Bower WF, Jin L, Underwood MJ, Lam YH, Lai PBS. Peri-operative blood transfusion increases length of hospital stay and number of postoperativecomplications in non-cardiac surgical patients. Hong Kong Med J. 2010;16(2):116-120.
  • Patel RS. Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck. Head Neck. 2014;36(10):1391. https://doi.org/10.1002/HED
  • Ñamendys-Silva SA, González-Herrera MO, Texcocano-Becerra J, Herrera-Gómez A. Hypoalbuminemia in critically ill patients with cancer: Incidence and mortality. Am J Hosp Palliat Med. 2011;28(4):253-257. https://doi.org/10.1177/1049909110384841
  • Chalela R, González-García JG, Chillarón JJ, Valera-Hernandez L, Montoya-Rangel C, Badenes D et al. Impact of hyponatremia on mortality and morbidity in patients with COPD exacerbations. Respir Med. 2016;117:237-242. https://doi.org/10.1016/j. rmed.2016.05.003
  • Feinstein AJ, Davis J, Gonzalez L, Blackwell KE, Abemayor E, Mendelsohn AH. Hyponatremia and perioperative complications in patients with head and neck squamous cell carcinoma. Head Neck. 2016;38(1):1370-1374. https://doi.org/10.1002/hed.24229
  • Carniol ET, Marchiano E, Brady JS, Merchant AM, Eloy JA, Baredes S et al. Head and neck microvascular free flap reconstruction: An analysis of unplanned readmissions. Laryngoscope. 2017;127(2):325-330. https://doi.org/10.1002/lary.26039
  • Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Mills SD, Pigazzi A, Stamos MJ. Preoperative leukocytosis in colorectal cancer patients. J Am Coll Surg. 2015;221(1):207-214. https://doi. org/10.1016/j.jamcollsurg.2015.03.044
  • Huang KH, Kaplan AL, Carter SC, Lipsitz SR, Hu JC. The impact of radical prostatectomy operative time on outcomes and costs. Urology. 2014;83(6):1265-1272. https://doi.org/10.1016/j. urology.2014.01.047
  • Lahtinen S, Koivunen P, Ala-Kokko T, Kaarela O, Ohtonen P, Laurila P et al. Complications and outcome after free flap surgery for cancer of the head and neck. Br J Oral Maxillofac Surg. 2018;56(8):684-691. https://doi.org/10.1016/j.bjoms.2018.07.009
  • Goh CSL, Kok YO, Yong CPC, Tan EWX, Goh LG, Chew KY et al. Outcome predictors in elderly head and neck free flap reconstruction: A retrospective study and systematic review of the current evidence. J Plast Reconstr Aesthetic Surg. 2018;71(5):719- 728. https://doi.org/10.1016/j.bjps.2017.12.011
  • Ren ZH, Wu HJ, Tan HY, Wang K, Zhang S. Transfer of anterolateral thigh flaps in elderly oral cancer patients: Complications in oral and maxillofacial reconstruction. J Oral Maxillofac Surg. 2015;73(3):534-540. https://doi.org/10.1016/j.joms.2014.09.021
  • Pohlenz P, Klatt J, Schmelzle R, Li L. The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology. Br J Oral Maxillofac Surg. 2013;51(6):508-513. https://doi.org/10.1016/j.bjoms.2012.10.020

Postanestezi bakım ünitesinde takip edilen majör baş-boyun cerrahisi geçiren hastaların değerlendirilmesi: 6 yıllık retrospektif analiz

Year 2022, Volume: 13 Issue: 47, 259 - 266, 15.12.2022
https://doi.org/10.17944/mkutfd.983464

Abstract

Amaç: Çalışmada son altı yılda major baş boyun cerrahisi geçiren ve post-anestezi yoğun bakım ünitesinde (PABÜ) takip edilen hastaların verileri retrospektif olarak incelenerek, postoperatif sonuçlara etki eden faktörlerin belirlenmesi amaçlandı.

Yöntem: Major baş boyun cerrahisi geçiren ve PABÜ’de postoperatif takibi yapılan hastaların demografik özellikleri, komorbiditeleri, preoperatif laboratuvar bulguları, hastalık evreleri, cerrahi özellikleri, intraoperatif ve postoperatif takip bulguları, komplikasyonları, yatış süreleri, morbiditeleri probel sistemi ve hasta dosyaları incelenerek kayıt ve analiz edildi.

Bulgular: Çalışmaya toplam 74 major baş boyun cerrahisi olgusu dahil edildi. Preoperatif sodyum düzeyleri ve intraoperatif kan transfüzyonu ile postoperatif mekanik ventilasyon (MV) süresi arasında istatistiksel anlamlı ilişki saptanmıştır. PABÜ yatış süresi ile 60 yaş üzeri olma, preoperatif albümin ve sodyum değerleri, nötrofil-lenfosit oranları (NLR), kan transfüzyonu ve MV süresi arasında ilişki olduğu belirlenmiştir. Yoğun bakım ihtiyacı gelişmesi ile preoperatif serum sodyum düzeyleri, operasyon süresi, kan transfüzyonu, MV süresi, PABÜ yatış süresi arasında istatistiksel anlamlı ilişki saptanmıştır. Mortalite ile PABÜ yatış süresi ve yoğun bakım ihtiyacı arasında istatistiksel olarak anlamlı ilişki gözlenmektedir.

Sonuç: Majör baş boyun cerrahisi hastalarında postoperatif sonuçlar üzerine, preoperatif elektrolit bozuklukları, nötrofil-lenfosit oranları, operasyon süresi, intraoperatif kan transfüzyonu, mekanik ventilasyon süresinin etkili faktörler arasında olduğu belirlenmiştir.

References

  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/ caac.21492
  • Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019 (US statistics). CA Cancer J Clin. 2019;69(1):7-34. https://doi.org/10.3322/ caac.21551
  • Nouraei SAR, Mace AD, Middleton SE, Hudovsky A, Vaz F, Moss C et al. 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. Clin Otolaryngol. 2017;42(1):11-28. https://doi.org/10.1111/coa.12649
  • Charters P, Ahmad I, Patel A, Russell S. Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(2):23-27. https://doi.org/10.1017/s0022215116000384
  • O’Dell K. Predictors of difficult intubation and the otolaryngology perioperative consult. Anesthesiol Clin. 2015;33(2):279-290. https://doi.org/10.1016/j.anclin.2015.02.002
  • Robson A, Sturman J, Williamson P, Conboy P, Penney S, Wood H. Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(2):13-22. https://doi.org/10.1017/s0022215116000372
  • Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG et al. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013 Feb;118(2):251-70. https://doi.org/10.1097/ALN.0b013e31827773b2.
  • Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77(2):217-222. https://doi.org/10.1093/ bja/77.2.217
  • Godden DRP, Patel M, Baldwin A, Woodwards RTM. Need for intensive care after operations for head and neck cancer surgery. Br J Oral Maxillofac Surg. 1999;37(6):502-505. https://doi. org/10.1054/bjom.1999.0194
  • Arshad H, Ozer HG, Thatcher A, Old M, Ozer E, Agarwal A, et al. Intensive care unit versus non-intensive care unit postoperative management of head and neck free flaps: comparative effectiveness and cost comparisons. Head Neck. 2014;36(10):536- 539. https://doi.org/10.1002/hed.23325
  • İnal DG, Omur D, Hancı V. Postanestezi̇k bakim üni̇tesi̇ (pabü): gelişimi ve standartlari. 2016;56(3):191-196
  • Strauss M, Bellian K. Otolaryngology care unit: a safe and cost-reducing way to deliver quality care. Laryngoscope. 1999;109(9):1428-1432. https://doi.org/10.1097/00005537- 199909000-00013
  • American Society of Anesthesiologists committee of origin: standards and practice parameters. Standards for Postanesthesia Care; 2014. (https://www.asahq.org/standards-and-guidelines/ standards-for-postanesthesia-care)
  • Fakhry C, Lacchetti C, Rooper LM, Jordan RC, Rischin D, Sturgis EM et al. Human papillomavirus testing in head and neck carcinomas: ASCO clinical practice guideline endorsement of the college of American pathologists guideline. J Clin Oncol. 2018;36(31):3152-3161. https://doi.org/10.1200/JCO.18.00684
  • Petrar S, Bartlett C, Hart RD, MacDougall P. Pulmonary complications after major head and neck surgery: A retrospective cohort study. Laryngoscope. 2012;122(5):1057-1061. https://doi.org/10.1002/lary.23228
  • Boruk M, Chernobilsky B, Rosenfeld RM, Har-El G. Age as a prognostic factor for complications of major head and neck surgery. Arch Otolaryngol - Head Neck Surg. 2005;131(7):605-609. https://doi.org/10.1001/archotol.131.7.605
  • Eytan DF, Blackford AL, Eisele DW, Fakhry C. Prevalence of comorbidities and effect on survival in survivors of human papillomavirus-related and human papillomavirus unrelated head and neck cancer in the United States. Cancer. 2019;125(2):249-260. https://doi.org/10.1002/cncr.31800
  • Meerwein C, Pézier TF, Beck-Schimmer B, Schmid S, Huber GF. Airway management in head and neck cancer patients undergoing microvascular free tissue transfer: Delayed extubation as an alternative to routine tracheotomy. Swiss Med Wkly. 2014;144(March):1-8. https://doi.org/10.4414/smw.2014.13941
  • Kipps AK , Wypij D, Thiagarajan RR, Bacha EA, Newburger JW. Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery. Pediatr Crit Care Med. 2011 January ; 12(1): 52-56. https://doi.org/10.1097/PCC.0b013e3181e30d43.BLOOD
  • Nguyen A, Shin H, Saint-Cyr M, Verheyden C. Blood loss and transfusion rates in microsurgical head and neck reconstruction. Plast Reconstr Surg - Glob Open. 2018;6(11):1-4. https://doi.org/10.1097/GOX.0000000000001988
  • Szakmany T, Dodd M, Dempsey GA, Lowe D, Brown JS, Vaughan ED et al. The influence of allogenic blood transfusion in patients having free-flap primary surgery for oral and oropharyngeal squamous cell carcinoma. Br J Cancer. 2006;94(5):647-653. https://doi.org/10.1038/sj.bjc.6603013
  • Sakr Y, Lobo S, Knuepfer S, Esser E, Bauer M, Settmacher U et al. Anemia and blood transfusion in a surgical intensive care unit. Crit Care. 2010;14(3). https://doi.org/10.1186/cc9026
  • Puram SV., Yarlagadda BB, Sethi R, Muralidhar V, Chambers KJ, Emerick KS et al. Transfusion in Head and Neck Free Flap Patients: Practice Patterns and a Comparative Analysis by Flap Type. Otolaryngol Neck Surg. 2015;152(3):449-457. https://doi. org/10.1177/0194599814567107
  • Bower WF, Jin L, Underwood MJ, Lam YH, Lai PBS. Peri-operative blood transfusion increases length of hospital stay and number of postoperativecomplications in non-cardiac surgical patients. Hong Kong Med J. 2010;16(2):116-120.
  • Patel RS. Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck. Head Neck. 2014;36(10):1391. https://doi.org/10.1002/HED
  • Ñamendys-Silva SA, González-Herrera MO, Texcocano-Becerra J, Herrera-Gómez A. Hypoalbuminemia in critically ill patients with cancer: Incidence and mortality. Am J Hosp Palliat Med. 2011;28(4):253-257. https://doi.org/10.1177/1049909110384841
  • Chalela R, González-García JG, Chillarón JJ, Valera-Hernandez L, Montoya-Rangel C, Badenes D et al. Impact of hyponatremia on mortality and morbidity in patients with COPD exacerbations. Respir Med. 2016;117:237-242. https://doi.org/10.1016/j. rmed.2016.05.003
  • Feinstein AJ, Davis J, Gonzalez L, Blackwell KE, Abemayor E, Mendelsohn AH. Hyponatremia and perioperative complications in patients with head and neck squamous cell carcinoma. Head Neck. 2016;38(1):1370-1374. https://doi.org/10.1002/hed.24229
  • Carniol ET, Marchiano E, Brady JS, Merchant AM, Eloy JA, Baredes S et al. Head and neck microvascular free flap reconstruction: An analysis of unplanned readmissions. Laryngoscope. 2017;127(2):325-330. https://doi.org/10.1002/lary.26039
  • Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Mills SD, Pigazzi A, Stamos MJ. Preoperative leukocytosis in colorectal cancer patients. J Am Coll Surg. 2015;221(1):207-214. https://doi. org/10.1016/j.jamcollsurg.2015.03.044
  • Huang KH, Kaplan AL, Carter SC, Lipsitz SR, Hu JC. The impact of radical prostatectomy operative time on outcomes and costs. Urology. 2014;83(6):1265-1272. https://doi.org/10.1016/j. urology.2014.01.047
  • Lahtinen S, Koivunen P, Ala-Kokko T, Kaarela O, Ohtonen P, Laurila P et al. Complications and outcome after free flap surgery for cancer of the head and neck. Br J Oral Maxillofac Surg. 2018;56(8):684-691. https://doi.org/10.1016/j.bjoms.2018.07.009
  • Goh CSL, Kok YO, Yong CPC, Tan EWX, Goh LG, Chew KY et al. Outcome predictors in elderly head and neck free flap reconstruction: A retrospective study and systematic review of the current evidence. J Plast Reconstr Aesthetic Surg. 2018;71(5):719- 728. https://doi.org/10.1016/j.bjps.2017.12.011
  • Ren ZH, Wu HJ, Tan HY, Wang K, Zhang S. Transfer of anterolateral thigh flaps in elderly oral cancer patients: Complications in oral and maxillofacial reconstruction. J Oral Maxillofac Surg. 2015;73(3):534-540. https://doi.org/10.1016/j.joms.2014.09.021
  • Pohlenz P, Klatt J, Schmelzle R, Li L. The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology. Br J Oral Maxillofac Surg. 2013;51(6):508-513. https://doi.org/10.1016/j.bjoms.2012.10.020
There are 35 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Melike Gencer This is me 0000-0003-3078-0661

Yüksel Erkin This is me 0000-0002-5859-2817

Volkan Hancı 0000-0002-2227-194X

Publication Date December 15, 2022
Submission Date August 16, 2021
Acceptance Date June 15, 2022
Published in Issue Year 2022 Volume: 13 Issue: 47

Cite

Vancouver Gencer M, Erkin Y, Hancı V. Postanestezi bakım ünitesinde takip edilen majör baş-boyun cerrahisi geçiren hastaların değerlendirilmesi: 6 yıllık retrospektif analiz. mkutfd. 2022;13(47):259-66.