Contemporary Morbidity and Mortality in Head and Neck Surgery

Abstract

Objective: 1) Understand contemporary data for morbidity and mortality in head and neck surgery (HNS). 2) Identify factors that influence length of stay (LOS) to be targeted for quality improvement.

Method: A database specific for patients undergoing inpatient primary head and neck surgical procedures was extracted from the National Hospital Data Survey (2005-2007). The frequency of perioperative complications, mortality, and LOS were quantified. The influence of these medical complications on mortality and LOS were determined with multivariate statistics.

Results: An estimated total of 330,629 ± 9097 head and neck patient-procedures were studied (mean age, 53.0 ± 0.6 years; 63% female). The overall medical morbidity and mortality rates were 5.0 ± 0.7% and 0.4 ± 0.2%, respectively. The most common medical complications were hospital-acquired pneumonia (3.3 ± 0.6%), acute renal failure (0.9 ± 0.2%), stroke (0.6 ± 0.4%), acute myocardial infarction (0.3 ± 0.1%), pulmonary embolism (0.2 ± 0.1%), and deep venous thrombosis (0.1 ± 0.1%). The mean LOS for patients without a major complication was 3.30 ± 0.2 days vs 14.0 ± 1.9 with a major complication (P < .001). The presence of a major medical complication did not increase mortality odds when adjusted for age, sex, and Charlson comorbidity (P = .177).

Conclusion: Complication rates for inpatient HNS procedures have declined in the past decade, although complications are still associated with longer LOS. The presence of a postoperative complication is no longer significantly associated with increased mortality. Enhancements in perioperative medical management of HNS inpatients are likely responsible for these improved results.