Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy.
Eur Arch Otorhinolaryngol. 2020 Dec;277(12):3459-3467. doi: 10.1007/s00405-020-06084-7. Epub 2020 Jun 3.
All kinds of ear, nose, and throat and maxillofacial surgery (ENT/MFS) procedures are being increasingly performed in the elderly although old age is a major risk factor for increased postoperative complications. With only scarce evidence on the topic, surgeons are asked to critically evaluate their procedures' indications and outcomes to balance the treatment risks and benefits. Our primary aim was to identify predictive factors for surgical outcomes in this setting and to create a predictive model for a tailored risk assessment.
We analyzed a case series of 435 patients from an institutional clinical database at our academic tertiary care center. Multivariate logistic regression was used to identify all possible covariates and nomograms using stepwise backward method were generated. The performance was assessed by calibration curves and c-index.
Overall complication rate was 18.3% within the first 30 days and the need for re-intervention was 5.9%. For those under general anesthesia, we identified specific risk factors and developed three risk-predicting models of overall, early, and late complications. All of the nomograms showed satisfactory accuracy with a c-index of 0.83, 0.75, 0.86, and 0.82, respectively.
Using clinical preoperative variables, we constructed a model for predicting major adverse events in ENT/MFS patients. In our experience, patients over 65 showed a non-negligible risk for postoperative complications depending on several factors. Such tools might help in decision-making, by increasing the risk-awareness of clinicians, to better address peri-operative and post-operative care of these patients.
尽管老年是术后并发症增加的主要危险因素，但各种耳鼻喉和颌面外科（ENT/MFS）手术在老年人中越来越多地进行。由于关于这个主题的证据很少，外科医生被要求批判性地评估他们的手术适应证和结果，以平衡治疗的风险和益处。我们的主要目的是确定该环境下手术结果的预测因素，并创建一个用于个性化风险评估的预测模型。
我们分析了来自我们学术三级护理中心机构临床数据库的 435 例患者的病例系列。使用多变量逻辑回归来识别所有可能的协变量，并使用逐步后退法生成列线图。通过校准曲线和 C 指数评估性能。
在 30 天内，总体并发症发生率为 18.3%，需要再次干预的比例为 5.9%。对于全身麻醉的患者，我们确定了特定的危险因素，并开发了三种预测总体、早期和晚期并发症的风险预测模型。所有的列线图都表现出令人满意的准确性，C 指数分别为 0.83、0.75、0.86 和 0.82。
使用临床术前变量，我们构建了一个预测 ENT/MFS 患者主要不良事件的模型。根据我们的经验，65 岁以上的患者根据几个因素显示出不可忽视的术后并发症风险。这些工具可能有助于通过提高临床医生的风险意识来做出决策，从而更好地处理这些患者的围手术期和术后护理。
