A national overview of surgical misadventures in head and neck surgery: "Oh No, You Cut It".

OBJECTIVES/HYPOTHESIS: To examine the risk and prevalence of accidental intraoperative injury reported during head and neck surgeries and the associated outcomes.

STUDY DESIGN

Retrospective cross-sectional analysis.

METHODS

An analysis utilizing the Nationwide Readmissions Database, 2010 to 2014. Adult patients with a reported accidental intraoperative injury were compared to controls without such injuries.

RESULTS

A total of 173 cases and 105,659 controls were included. Most cases were reported in surgeries of the mouth/tonsils (29.4%) and maxillofacial bones/mandible (22.5%). The remaining cases were reported in surgeries of the pharynx/larynx (17.5%), nose/paranasal sinuses (15.4%), salivary glands and ducts (6.2%), thyroid/parathyroid (5.2%), and ear (3.8%). The multivariate logistic regression model demonstrated that surgeries of the pharynx/larynx were associated with the highest risk of injuries compared to other site surgeries (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.49, 4.25, P < .001]. Concomitant neck dissection was also independently associated with the risk of injury (OR: 4.07, 95% CI: 2.05, 8.09, P < .001]. Compared to controls, cases were not associated with an increased risk of mortality (P = .63) or readmission (P = .29); however, those cases had a significantly longer hospital stay on average by 3.64 ± 0.95 days/case (P < .001) and a higher cost of treatment on average by $13,478 ± 119.42/case (P < .001).

CONCLUSIONS

This study reports on the prevalence and outcomes of accidental intraoperative injuries reported in head and neck surgeries. The prevalence is relatively low, and the annual trend appears stable; however, it is associated with a significant burden on the health system.

LEVEL OF EVIDENCE

NA Laryngoscope, 130:918-924, 2020.