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.
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.
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).
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: email@example.com.