Race and Ethnicity Independently Predict Adverse Outcomes Following Head and Neck Autograft Surgery

Tatiana Ferraro; Abdulla K Ahmed; Esther Lee; Sean M Lee; Peter M Debbaneh; Punam Thakkar; Arjun Joshi; Neelima Tummala

doi:10.1002/lary.31367

Race and Ethnicity Independently Predict Adverse Outcomes Following Head and Neck Autograft Surgery

Laryngoscope. 2024 Feb 26. doi: 10.1002/lary.31367. Online ahead of print.

Authors

Tatiana Ferraro^{1

2}, Abdulla K Ahmed¹, Esther Lee¹, Sean M Lee³, Peter M Debbaneh⁴, Punam Thakkar¹, Arjun Joshi¹, Neelima Tummala¹

Affiliations

¹ Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A.
² Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A.
³ Office of Clinical Research, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A.
⁴ Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente East Bay, Oakland, California, U.S.A.

PMID: 38407481
DOI: 10.1002/lary.31367

Abstract

Objective: There is growing attention toward the implications of race and ethnicity on health disparities within otolaryngology. While race is an established predictor of adverse head and neck oncologic outcomes, there is paucity in the literature on studies employing national, multi-institutional data to assess the impact of race and ethnicity on head and neck autograft surgery.

Methods: Using the National Surgical Quality Improvement Program (NSQIP) database, trends in 30 days outcomes were assessed. Patients with ICD-10 codes for malignant head and neck neoplasms were isolated. Autograft surgeries were selected using Current Procedural Terminology (CPT) codes for free flap and pedicled flap reconstruction. Primary outcomes included surgical complications, reoperation, readmission, extended length of stay and operation time. Each binary categorical variable was compared to racial/ethnic identity via binary logistic regression.

Results: The study cohort consisted of 2447 patients who underwent head and neck autograft surgery (80.71% free flap reconstruction and 19.39% pedicled flap reconstruction). Black patients had significantly higher odds of overall surgical complications (odds ratio [OR] 1.583, 95% confidence interval [CI] 1.091, 2.298, p = 0.016) with much higher odds of perioperative blood transfusions (OR 2.291, 95% CI 1.532, 3.426, p = <.001). Hispanic patients were more likely to undergo reoperation within 30 days after surgery and were more likely to be hospitalized for more than 30 days post-operatively (OR 1.566, 95% CI 1.015, 2.418, p = 0.043 and OR 12.224, 95% CI 2.698, 55.377, p = 0.001, respectively).

Conclusions: Race and ethnicity serve as independent predictors of complications in the post-operative period following head and neck autograft surgery.

Level of evidence: III Laryngoscope, 2024.

Keywords: NSQIP; ethnicity; head and neck surgery; health disparities; microvascular surgery; race; racial disparities; reconstructive surgery.