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A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an informatics-based outcomes surveillance framework

A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an informatics-based outcomes surveillance framework
A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an informatics-based outcomes surveillance framework

Objectives: To perform a national analysis of the perioperative outcome of major head and neck cancer surgery to develop a stratification strategy and outcomes assessment framework using hospital administrative data. 

Design: A Hospital Episode Statistics N = near-all analysis. 

Settings: The English National Health Service. 

Main outcome measures: Local audit data were used to assess and triangulate the quality of the administrative dataset. Within the national dataset, cancer sites, morbidities, social deprivation, treatment, complications, and in-hospital mortality were recorded. 

Results: Within local audit datasets, the accuracy of assigning newly-derived Cancer Site Strata and Resection Strata were 92.3% and 94.2%, respectively. Accuracy of morbidities assignment was 97%. Within the national dataset, we identified 17 623 major head and neck cancer resections between 2002 and 2012. There were 12 413 males and mean age at surgery was 63 ± 12 years. The commonest cancer site strata were oral cavity (42%) and larynx–hypopharynx (32%). The commonest resection site was the larynx (n = 4217), and 13 211 and 11 841 patients had neck dissection and flap-based reconstruction, respectively. There were prognostically significant baseline differences between patients with oromandibular and pharyngolaryngeal malignancy. Patients with pharyngolaryngeal malignancies had a greater burden of morbidities, lower socio-economic status, fewer primary resections, and a sixfold increased risk of undergoing their major resection during an emergency hospital admission. Mean length of stay was 25 days and each complication linearly increased it by 9.6 days. There were 609 (3.5%) in-hospital deaths and a basket of seven medical and three surgical complications significantly increased the risk of in-hospital death. At least one potentially lethal complication occurred in 26% of patients. The risk of in-hospital death in a patient with no potentially lethal complication was 1.1% and this increased to 6% with one potentially lethal complication, and to 15.1% if two potentially lethal complications occurred in one patient. Complex oral-pharyngeal resections and pharyngolaryngectomies had the highest risks of complications and mortality. 

Conclusion: Mortality following head and neck cancer surgery shows variation across different resection strata. We propose an Informatics-based Framework for Outcomes Surveillance (IFOS) in Head and Neck Surgery for perpetual quality assurance, using the local hospital coding data or its collated destination, the national administrative dataset.

1749-4478
11-28
Nouraei, S. A.R.
f09047ee-ed51-495d-a257-11837e74c2b3
Mace, A. D.
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Middleton, S. E.
9651c86e-07fb-4581-9e82-95fea47d68a2
Hudovsky, A.
5e7c2396-f1f3-4587-b107-90d6bec11c4c
Vaz, F.
ba6841e6-8ce6-4015-a24e-8538df435147
Moss, C.
ae96895f-5c4a-49cd-a771-53bbd6f1d5fb
Ghufoor, K.
bbc64bf3-9a56-4575-9fde-6f6187490712
Mendes, R.
570f09e6-fe00-4da5-8f1e-791381e7ac58
O'Flynn, P.
d2e845e6-f6c5-46a8-8f83-8ce3d13be427
Jallali, N.
d84d7346-2d2a-4b4f-ae43-2be7f378c201
Clarke, P. M.
38d22453-c6f4-44e2-87b9-b2f4e5941569
Darzi, A.
458f5a39-b0b0-484b-96cd-06613afdf011
Aylin, P.
7cfbb619-0776-4c4f-a9d7-d4f07ee459b1
Nouraei, S. A.R.
f09047ee-ed51-495d-a257-11837e74c2b3
Mace, A. D.
0628d9d4-276a-4467-9475-cff6b536c99b
Middleton, S. E.
9651c86e-07fb-4581-9e82-95fea47d68a2
Hudovsky, A.
5e7c2396-f1f3-4587-b107-90d6bec11c4c
Vaz, F.
ba6841e6-8ce6-4015-a24e-8538df435147
Moss, C.
ae96895f-5c4a-49cd-a771-53bbd6f1d5fb
Ghufoor, K.
bbc64bf3-9a56-4575-9fde-6f6187490712
Mendes, R.
570f09e6-fe00-4da5-8f1e-791381e7ac58
O'Flynn, P.
d2e845e6-f6c5-46a8-8f83-8ce3d13be427
Jallali, N.
d84d7346-2d2a-4b4f-ae43-2be7f378c201
Clarke, P. M.
38d22453-c6f4-44e2-87b9-b2f4e5941569
Darzi, A.
458f5a39-b0b0-484b-96cd-06613afdf011
Aylin, P.
7cfbb619-0776-4c4f-a9d7-d4f07ee459b1

Nouraei, S. A.R., Mace, A. D., Middleton, S. E., Hudovsky, A., Vaz, F., Moss, C., Ghufoor, K., Mendes, R., O'Flynn, P., Jallali, N., Clarke, P. M., Darzi, A. and Aylin, P. (2017) A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an informatics-based outcomes surveillance framework. Clinical Otolaryngology, 42 (1), 11-28. (doi:10.1111/coa.12649).

Record type: Article

Abstract

Objectives: To perform a national analysis of the perioperative outcome of major head and neck cancer surgery to develop a stratification strategy and outcomes assessment framework using hospital administrative data. 

Design: A Hospital Episode Statistics N = near-all analysis. 

Settings: The English National Health Service. 

Main outcome measures: Local audit data were used to assess and triangulate the quality of the administrative dataset. Within the national dataset, cancer sites, morbidities, social deprivation, treatment, complications, and in-hospital mortality were recorded. 

Results: Within local audit datasets, the accuracy of assigning newly-derived Cancer Site Strata and Resection Strata were 92.3% and 94.2%, respectively. Accuracy of morbidities assignment was 97%. Within the national dataset, we identified 17 623 major head and neck cancer resections between 2002 and 2012. There were 12 413 males and mean age at surgery was 63 ± 12 years. The commonest cancer site strata were oral cavity (42%) and larynx–hypopharynx (32%). The commonest resection site was the larynx (n = 4217), and 13 211 and 11 841 patients had neck dissection and flap-based reconstruction, respectively. There were prognostically significant baseline differences between patients with oromandibular and pharyngolaryngeal malignancy. Patients with pharyngolaryngeal malignancies had a greater burden of morbidities, lower socio-economic status, fewer primary resections, and a sixfold increased risk of undergoing their major resection during an emergency hospital admission. Mean length of stay was 25 days and each complication linearly increased it by 9.6 days. There were 609 (3.5%) in-hospital deaths and a basket of seven medical and three surgical complications significantly increased the risk of in-hospital death. At least one potentially lethal complication occurred in 26% of patients. The risk of in-hospital death in a patient with no potentially lethal complication was 1.1% and this increased to 6% with one potentially lethal complication, and to 15.1% if two potentially lethal complications occurred in one patient. Complex oral-pharyngeal resections and pharyngolaryngectomies had the highest risks of complications and mortality. 

Conclusion: Mortality following head and neck cancer surgery shows variation across different resection strata. We propose an Informatics-based Framework for Outcomes Surveillance (IFOS) in Head and Neck Surgery for perpetual quality assurance, using the local hospital coding data or its collated destination, the national administrative dataset.

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More information

Accepted/In Press date: 8 March 2016
e-pub ahead of print date: 15 March 2016
Published date: 1 February 2017

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Local EPrints ID: 439646
URI: http://eprints.soton.ac.uk/id/eprint/439646
ISSN: 1749-4478
PURE UUID: b20073f2-65a3-4efe-ba9f-9a5fcbc289e6

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Date deposited: 29 Apr 2020 16:30
Last modified: 16 Mar 2024 07:38

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Contributors

Author: S. A.R. Nouraei
Author: A. D. Mace
Author: S. E. Middleton
Author: A. Hudovsky
Author: F. Vaz
Author: C. Moss
Author: K. Ghufoor
Author: R. Mendes
Author: P. O'Flynn
Author: N. Jallali
Author: P. M. Clarke
Author: A. Darzi
Author: P. Aylin

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