Faculty Collaboration Database

Carotid Body Tumor Resection: Just as Safe without Preoperative Embolization. Ann Vasc Surg 2018 Jan;46:54-59

Date

07/12/2017

Pubmed ID

28689940

Pubmed Central ID

PMC5726906

DOI

10.1016/j.avsg.2017.06.149

Scopus ID

2-s2.0-85027579779 (requires institutional sign-in at Scopus site)   48 Citations

Abstract

BACKGROUND: Carotid body tumors (CBTs) are rare entities for which surgical resection remains the gold standard. Given their hypervascularity, preoperative embolization is often used; however, controversy exists over whether a benefit is associated. Proponents of embolization argue that it minimizes blood loss and complications. Critics argue that cost and stroke outweigh benefits. This study aimed to investigate the impact of embolization on outcomes following CBT resection.

METHODS: Patients undergoing CBT resection were identified using the Healthcare Cost and Utilization Project State Inpatient Database for 5 states between 2006 and 2013. Patients were divided into 2 groups: carotid body tumor resection alone (CBTR) and carotid body tumor resection with preoperative arterial embolization (CBETR). Descriptive statistics were calculated using arithmetic means with standard deviations for continuous variables and proportions for categorical variables. Patients were propensity score matched on the basis of sex, age, race, insurance, and comorbidity prior to analysis. Risk-adjusted odds of mortality, stroke, nerve injury, blood loss, and length of stay (LOS) were calculated using mixed-effects regression models with fixed effects for age, race, sex, and comorbidities.

RESULTS: A total of 547 patients were identified. Of these, 472 patients underwent CBTR and 75 underwent CBETR. Mean age was 54.7 ± 16 years. Mean number of days between embolization and resection was 0.65 ± 0.72 days (range 0-3). When compared with CBTR, there were no significant differences in mortality for CBETR (1.35% vs. 0%, P = 0.316), cranial nerve injury (2.7% vs. 0%, P = 0.48), and blood loss (2.7% vs. 6.8%, P = 0.245). Following risk adjustment, CBETR increased the odds of prolonged LOS (odds ratio 5.3, 95% confidence interval 2.1-13.3).

CONCLUSIONS: CBT resection is a relatively rare procedure. The utility of preoperative tumor embolization has been questioned. This study demonstrates no benefit of preoperative tumor embolization.

Author List

Cobb AN, Barkat A, Daungjaiboon W, Halandras P, Crisostomo P, Kuo PC, Aulivola B

Author

Adrienne Cobb MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Blood Loss, Surgical
Carotid Body Tumor
Clinical Decision-Making
Cranial Nerve Injuries
Databases, Factual
Decision Trees
Embolization, Therapeutic
Female
Humans
Length of Stay
Logistic Models
Male
Middle Aged
Odds Ratio
Patient Selection
Propensity Score
Risk Assessment
Risk Factors
Stroke
Time Factors
Treatment Outcome
United States
Unnecessary Procedures
Vascular Surgical Procedures