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

Bukatko, Aleksandr R. MPH, CPH*,†; Patel, Parth B. MD, MPH*; Kakarla, Vindhya MD, MPH*,‡; Simpson, Matthew C. MPH; Adjei Boakye, Eric PhD; Patel, Shivam H. BS§; Stamatakis, Katherine A. PhD, MPH*; Varvares, Mark A. MD, FACS; Osazuwa-Peters, Nosayaba BDS, PhD, MPH, CHES†,¶

American Journal of Clinical Oncology: July 2019 - Volume 42 - Issue 7 - p 596–601
doi: 10.1097/COC.0000000000000557
Original Articles: Head and Neck

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.

*Saint Louis University College for Public Health and Social Justice

Department of Otolaryngology-Head and Neck Surgery

§Saint Louis University School of Medicine

Saint Louis University Center for Health Outcomes Research (SLUCOR)

Saint Louis University Cancer Center, St. Louis, MO

Department of Otolaryngology, Harvard Medical School, Boston, MA

The authors declare no conflicts of interest.

Reprints: Nosayaba Osazuwa-Peters, BDS, PhD, MPH, CHES, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 6th Floor Desloge Towers, St. Louis, MO 63110-2539. E-mail:

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