Author(s)
Joseph S. Weisberger, MS
Monica C Azmy, BS
Greg L. Barinsky, PharmD
Marcus L. Elias, BS
Jean A. Eloy, MD
Soly Baredes, MD
Richard C. Park, MD
Affiliation(s)
Rutgers New Jersey Medical School
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to discuss the impact of hemostatic disorder on postoperative outcomes in patients undergoing major head and neck surgeries. Objectives: To investigate the impact of an abnormal hemostatic profile on postoperative complications following major head and neck surgeries. Study Design: Retrospective database review. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for all major head and neck surgeries (glossectomy, mandibulectomy, laryngectomy, pharyngectomy and esophagectomy) performed by otolaryngologists between 2005 and 2014 (n=2084). The independent variables analyzed via univariate and multivariate logistic regression were defined as thrombocytopenia (platelets<150,000), thrombocytosis (platelets>450,000), anemia (male hematocrit<39%; female hematocrit <36%), abnormal INR (>1.1), and bleeding disorders (deficiencies of blood clotting elements). Results: Binary logistical regression-controlling for age, sex, race, and significant comorbidities found through univariate analysis-yielded statistically significant differences in postoperative outcomes for all independent variable cohorts except the thrombocytopenia group. Thrombocytosis predicted the risk for superficial surgical site infection (OR=3.159, p=0.004), surgical complications (OR=2.397, p=0.001) and overall complications (OR=2.307, p=0.003). The abnormal INR subgroup demonstrated increased risk for urinary tract infection (OR=7.592, p=0.002). Anemic patients showed an increased risk for wound disruption (OR=2.131, p= 0.002), being placed on a ventilator for more than 48 hours (OR=1.708, p=0.034), bleeding (OR=4.262, p<0.001), surgical complications (OR=3.015, p<0.001), medical complications (OR=1.476, p=0.010), and overall complications (OR=2.6705, p<0.001). Patients with bleeding disorders were at an increased risk of surgical complications (OR=2.357, p=0.004), and overall complications (OR=1.839, p=0.040). Conclusions: Hemostatic disorder predicted the likelihood of several different postoperative outcomes in patients undergoing major head and neck surgeries. However, thrombocytopenia did not indicate variations in outcome probability.