American Association of Plastic Surgeons

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Head and Neck Reconstruction by Plastic Surgeons Results in Fewer Surgical Complications Compared to ENT: A Propensity-Matched Analysis of 30-Day Outcomes
Marten N. Basta, MD, Daniel Kwan, MD, Karl H. Breuing, MD, Charles C. Jehle, MD, Paul Y. Liu, MD, Albert S. Woo, MD.
Brown University and Rhode Island Hospital, Providence, RI, USA.

PURPOSE:
Head and neck cancer resections often necessitate a multidisciplinary approach to reconstruction. Recent trends, however, indicate more ENT reconstructions without involvement by plastic surgeons (PRS). This study compared 30-day outcomes for patients reconstructed by PRS vs. ENT surgeons using the NSQIP datasets.
METHODS:
NSQIP 2009-2015 databases were queried for all adult patients with a head and neck cancer diagnosis undergoing resection followed by immediate reconstruction by either an ENT or Plastic Surgeon. Patients were propensity-matched by comorbidities and resection/reconstructive characteristics and surgical complications compared among the two cohorts.
RESULTS:
491 propensity-matched patients were included (ENT-263, PRS-228). Age, gender, ethnicity, obesity, and comorbidities were no different among the two cohorts. PRS reconstructions more commonly involved: nasopharynx (8% vs. 1%), tongue (44% vs. 30%), parotid (8% vs. 5%), while ENT more commonly reconstructed laryngeal (12% vs. 5%) and floor of mouth defects (14% vs. 6%). 67% of cases involved free tissue transfer (PRS-75%, ENT-60%, p<0.001). Incidence of surgical complications=36.7%. Despite adjusting for confounders, PRS-reconstruction was associated with significantly fewer surgical complications (OR=0.38, p<0.001), infection (OR=0.56, p=0.048), dehiscence (OR=0.33, p=0.029), and readmissions (OR=0.51, p=0.03). Medical complications, however, were no different between the 2 groups (ENT-19%, PRS-16%).
CONCLUSION:
Among a propensity-matched cohort, PRS-reconstruction led to significantly fewer wound complications but not medical complications. Head and neck surgical outcomes are likely to improve with greater involvement of plastic surgeons.


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