Performance of parotidectomy in nonspecialist centers.

OBJECTIVE

To ascertain whether parotidectomy could be safely performed in smaller centers. The results of parotid surgery in a smaller center were reviewed and the major outcome measures compared with the results in the English literature from the best-known centers.

DESIGN

Retrospective analysis of case series comprising 168 consecutive parotid surgical procedures in a district general hospital for a 15-year period (1985-1999). The follow-up ranged from 1 to 15 years with a mean of 8 years. Sixty-three patients had a follow-up of over 10 years. Revision procedures and surgery for malignant tumors were excluded from the study.

SETTING

Warwick Hospital, a district general hospital in the United Kingdom, catering to a population of 300,000, with a case mix that is typical for a primary care hospital.

MAIN OUTCOME MEASURES

Permanent facial palsy, temporary facial palsy, and recurrence rate. Other variables included age, sex, name of the surgeon, histopathologic features of the specimen, duration of follow-up, and other complications.

RESULTS

There were 154 consecutive operations within the study period, performed by 2 ear, nose, and throat surgeons and 1 general surgeon. Eight cases were excluded because of cancer or revision, yielding a final figure of 146 for analysis. There were 25 cases of temporary facial palsy and no incidence of permanent facial palsy during the study period. However, recurrence of the tumor was noted in 4 patients, all of whom opted for revision surgery with successful outcomes.

CONCLUSIONS

Parotid surgery for benign disease can be as safely performed in smaller centers as in larger centers. However, our study did not support the view that only a specified single surgeon should do parotid surgery, since there is no significant difference in the major outcome measures between different surgeons.