All-Cause 30-Day Mortality After Surgical Treatment for Head and Neck Squamous Cell Carcinoma in the United States. (July 2019)

• Record Type: Journal Article
• Authors: Bukatko, Aleksandr R.; Patel, Parth B.; Kakarla, Vindhya; Simpson, Matthew C.; Adjei Boakye, Eric; Patel, Shivam H.; Stamatakis, Katherine A.; Varvares, Mark A.; Osazuwa-Peters, Nosayaba
• Is Part Of: American journal of clinical oncology. Volume 42:Number 7(2019)
• Publication Date: 2019-07
• Subjects: thirty (30)-day mortality -- short-term mortality -- head and neck squamous cell carcinoma (HNSCC) -- treatment-related disparities -- National Cancer Database (NCDB); Cancer -- Treatment -- Periodicals; Oncology -- Periodicals; Tumors -- Periodicals; 616.994005
• DOI: 10.1097/COC.0000000000000557
• Languages: English
• ISSNs: 0277-3732

Abstract

Abstract : Objectives: Thirty-day (30-day) mortality, a common posttreatment quality metric, is yet to be described following surgery for head and neck squamous cell carcinoma (HNSCC). This study aimed to measure 30-day postoperative mortality in HNSCC and describe clinical/nonclinical factors associated with 30-day mortality. Methods: In this retrospective cohort study, the National Cancer Database (2004 to 2013) was queried for eligible cases of HNSCC (n=91, 858). Adult patients were included who were treated surgically with curative intent for the primary HNSCC, not missing first treatment, survival, and follow-up information. The outcome of interest was all-cause mortality within 30 days of definitive surgery. Clinical and nonclinical factors associated with all-cause 30-day postoperative mortality were estimated using a fully adjusted, multivariable logistic regression, which accounted for time-varying nature of adjuvant therapy. Results: A total of 775 patients died within 30 days of definitive surgery for HNSCC (30-day mortality rate of 0.84%). Thirty-day mortality rate was however up to 2.33% (95% confidence interval [CI], 1.91%-2.75%) depending on comorbidity. In the fully adjusted model, increasing severity of comorbidity was associated with greater odds of 30-day mortality (Charlson-Deyo comorbidity scores of 1: adjusted odds ratio [aOR], 1.43; 95% CI, 1.21-1.69, and of 2+ aOR, 2.55; 95% CI, 2.07-3.14). Odds of 30-day mortality were greater among Medicaid patients (aOR, 1.77; 95% CI, 1.30-2.41), and in patients in neighborhoods with little education (≥ 29% missing high school diploma: aOR, 1.35; 95% CI, 1.02-1.78). Conclusions: Patients with higher 30-day mortality were those with a greater burden of comorbidities, with little education, and covered by Medicaid.