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A model to predict postoperative complications for otorhinolaryngology and maxillofacial surgery procedures in elderly patients

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

All kinds of ear, nose, and throat and maxillofacial surgery (ENT/MFS) procedures are being increasingly performed in the elderly although old age is a major risk factor for increased postoperative complications. With only scarce evidence on the topic, surgeons are asked to critically evaluate their procedures’ indications and outcomes to balance the treatment risks and benefits. Our primary aim was to identify predictive factors for surgical outcomes in this setting and to create a predictive model for a tailored risk assessment.

Methods

We analyzed a case series of 435 patients from an institutional clinical database at our academic tertiary care center. Multivariate logistic regression was used to identify all possible covariates and nomograms using stepwise backward method were generated. The performance was assessed by calibration curves and c-index.

Results

Overall complication rate was 18.3% within the first 30 days and the need for re-intervention was 5.9%. For those under general anesthesia, we identified specific risk factors and developed three risk-predicting models of overall, early, and late complications. All of the nomograms showed satisfactory accuracy with a c-index of 0.83, 0.75, 0.86, and 0.82, respectively.

Conclusion

Using clinical preoperative variables, we constructed a model for predicting major adverse events in ENT/MFS patients. In our experience, patients over 65 showed a non-negligible risk for postoperative complications depending on several factors. Such tools might help in decision-making, by increasing the risk-awareness of clinicians, to better address peri-operative and post-operative care of these patients.

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Funding

None. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy

    Luca Giovanni Locatello & Lara Valentina Comini

  2. Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy

    Alessandra Bettiol & Alfredo Vannacci

  3. Department of Maxillofacial Surgery, Careggi University Hospital, Largo Brambilla, 3, Florence, 50134, Italy

    Giuseppe Spinelli

  4. Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Giuditta Mannelli

Authors
  1. Luca Giovanni Locatello
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  2. Lara Valentina Comini
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  3. Alessandra Bettiol
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  4. Alfredo Vannacci
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  5. Giuseppe Spinelli
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  6. Giuditta Mannelli
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Corresponding author

Correspondence to Luca Giovanni Locatello.

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Conflict of interest

All authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Electronic supplementary material

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405_2020_6084_MOESM1_ESM.eps

Supplementary file1 Supplementary Figure 1. Receiver-operating characteristics (ROC) curve for the risk models on a) early complications, b) late complications, and c) need for re-intervention. (EPS 28073 kb)

405_2020_6084_MOESM2_ESM.eps

Supplementary file2 Supplementary Figure 2. Calibration plots for the risk models on a) early complications, b) late complications, and c) need for re-intervention. (EPS 20929 kb)

Supplementary file3 (RTF 221 kb)

Supplementary file4 (RTF 332 kb)

Supplementary file5 (RTF 261 kb)

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Locatello, L.G., Comini, L.V., Bettiol, A. et al. A model to predict postoperative complications for otorhinolaryngology and maxillofacial surgery procedures in elderly patients. Eur Arch Otorhinolaryngol 277, 3459–3467 (2020). https://doi.org/10.1007/s00405-020-06084-7

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  • DOI: https://doi.org/10.1007/s00405-020-06084-7

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