Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006 to 2011 NSQIP Data Sets

Abstract

Objectives:

Studies evaluating complications after neck dissection alone or in conjunction with other procedures are sparse. We looked for predictors of adverse events after neck dissection using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), which tracks 30-day complication rates in patients undergoing surgery at participating centers.

Methods:

In this retrospective review, 619 patients were identified using CPT codes specific for neck dissection. Clinical factors, comorbidities, epidemiologic factors, and procedure characteristics were analyzed with multiple regression to evaluate relationship to complication rates.

Results:

Twenty-three percent of patients (142 of 619 patients) underwent neck dissection and experienced either a medical or surgical complication. Factors associated with adverse events included previous cardiac surgery (odds ratio [OR] 3.376, 95% confidence interval [CI] 1.084-10.516, P = .036), dyspnea (OR 2.568, 95% CI 1.06-6.22, P = .037), total work RVUs (OR 1.085, OR 1.041–1.131, P = .001), and anesthesia time (OR 1.005, 95% CI 1-1.009, P = .036). Importantly, smoking, age, ASA class, and prior radiation or chemotherapy were not significant. Injury to accessory nerve and chyle leak are not specifically tracked in NSQIP.

Conclusions:

This study presents important benchmarks for medical and surgical complication rates, reoperation, and mortality observed with neck dissection in a large nationally abstracted patient sample. Cardiorespiratory morbidity and surgical complexity were found to be major drivers of complications. The true complication rates may be underrepresented due to inadequate tracking of procedure specific complications in NSQIP.