Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A.
Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A.
Laryngoscope. 2024 Aug;134(8):3595-3603. doi: 10.1002/lary.31367. Epub 2024 Feb 26.
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.
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.
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).
Race and ethnicity serve as independent predictors of complications in the post-operative period following head and neck autograft surgery.
3 Laryngoscope, 134:3595-3603, 2024.
人们越来越关注种族和民族对耳鼻喉科健康差异的影响。虽然种族是头颈部肿瘤不良预后的一个既定预测因素，但在使用国家多机构数据评估种族和民族对头颈自体移植物手术影响的研究中，文献却很少。
利用国家外科质量改进计划（NSQIP）数据库，评估了 30 天结局的趋势。分离出 ICD-10 编码为头颈部恶性肿瘤的患者。使用游离皮瓣和带蒂皮瓣重建的当前操作术语（CPT）代码选择自体移植物手术。主要结果包括手术并发症、再次手术、再入院、延长住院时间和手术时间。通过二元逻辑回归将每个二项分类变量与种族/民族身份进行比较。
研究队列包括 2447 名接受头颈部自体移植物手术的患者（80.71%为游离皮瓣重建，19.39%为带蒂皮瓣重建）。黑人患者总体手术并发症的几率明显更高（优势比[OR] 1.583，95%置信区间[CI] 1.091，2.298，p=0.016），围手术期输血的几率也高得多（OR 2.291，95% CI 1.532，3.426，p<.001）。西班牙裔患者在术后 30 天内再次手术的可能性更高，术后住院时间超过 30 天的可能性也更高（OR 1.566，95% CI 1.015，2.418，p=0.043 和 OR 12.224，95% CI 2.698，55.377，p=0.001）。
种族和民族是头颈部自体移植物手术后围手术期并发症的独立预测因素。
3 Laryngoscope，134：3595-3603，2024。
