Does neck dissection affect post-operative outcomes in parotidectomy? A national study

Philip R Brauer; Chandana A Reddy; Jamie A Ku; Brandon L Prendes; Eric D Lamarre

doi:10.1016/j.amjoto.2020.102593

Does neck dissection affect post-operative outcomes in parotidectomy? A national study

Am J Otolaryngol. 2020 Sep-Oct;41(5):102593. doi: 10.1016/j.amjoto.2020.102593. Epub 2020 Jun 5.

Authors

Philip R Brauer¹, Chandana A Reddy², Jamie A Ku³, Brandon L Prendes³, Eric D Lamarre⁴

Affiliations

¹ Case Western Reserve University School of Medicine, Cleveland, OH, USA; Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA.
² Taussig Cancer Institute, The Cleveland Clinic, Cleveland, OH, USA.
³ Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA.
⁴ Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA. Electronic address: lamarre@ccf.org.

PMID: 32521296
DOI: 10.1016/j.amjoto.2020.102593

Abstract

Objective: To characterize post-operative complications in parotidectomy with neck dissection.

Methods: Patients age ≥ 18 receiving a parotidectomy or parotidectomy with neck dissection between 2005 and 2017 were eligible for inclusion. Patients with unknown demographic variables were excluded. Univariate and multivariable logistic regression analyses were performed.

Results: A total of 13,609 parotidectomy patients were analyzed, 11,243 (82.6%) without neck dissection and 2366 (17.4%) with neck dissection. Both length of surgery (mean minutes ± standard deviation [SD] = 335.9 ± 189.2 vs. 152.9 ± 99.0, p < 0.001) and length of hospital stay (mean days ± SD = 3.90 ± 4.76 vs. 1.04 ± 2.14, p < 0.001) were greater with dissection. 13.9% of parotidectomies with neck dissection and 3.5% without dissection (p < 0.001) had at least one complication, which remained significant after multivariable adjustment (Odds Ratio[OR] = 1.565 (95%CI = 1.279-1.914), p < 0.001). The increase in post-operative complications was predominately driven by an increased transfusion rate (7.4% vs. 0.5%, p < 0.001). Multivariable analysis also demonstrated no significant difference in rates of returning to the operating room (OR = 1.122 (95%CI 0.843-1.493), p > 0.05) or rates of readmission (OR = 1.007 (95%CI 0.740-1.369), p > 0.05). Parotidectomy with neck dissection was more likely to be inpatient (OR = 4.411 (95%CI 3.887-5.004), p < 0.001) and to be ASA class 3 (OR = 1.367 (95%CI 1.194-1.564), p < 0.001).

Conclusions: Nationwide data demonstrates that parotidectomy with neck dissection is associated with increased rates of post-operative complications; however, neck dissection did not significantly impact readmission or reoperation rates. These findings indicate that neck dissection is a relatively safe addition to parotidectomy and provide novel evidence in the management of parotid malignancies.

Keywords: Metastasis; Neck dissection; Otolaryngology; Parotid cancer; Parotidectomy.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Blood Transfusion / statistics & numerical data
Data Interpretation, Statistical
Female
Humans
Length of Stay
Male
Middle Aged
Neck Dissection*
Operative Time
Oral Surgical Procedures / methods*
Parotid Gland / surgery*
Parotid Neoplasms / surgery*
Patient Readmission
Postoperative Complications / epidemiology*
Postoperative Complications / etiology*
Reoperation / statistics & numerical data
Retrospective Studies
Safety
Treatment Outcome
Young Adult