Faculty Collaboration Database

Postoperative hemorrhage and hospital revisit after transoral robotic surgery. Laryngoscope 2017 Oct;127(10):2287-2292

Date

04/21/2017

Pubmed ID

28425577

Pubmed Central ID

PMC7050677

DOI

10.1002/lary.26626

Scopus ID

2-s2.0-85018613600 (requires institutional sign-in at Scopus site)   34 Citations

Abstract

OBJECTIVES/HYPOTHESIS: To investigate the incidence and complications related to postoperative hemorrhage (POH) after transoral robotic surgery (TORS).

STUDY DESIGN: Retrospective review of the State Inpatient Database (SID), the State Ambulatory Surgery Database (SASD), and the State Emergency Department Database (SEDD) from the Healthcare Cost and Utilization Project.

METHODS: Patients were identified from the SID, SASD, and SEDD for the states of Florida, New York, and California from 2005 to 2013 who had an International Classification of Diseases, Ninth Edition code for a surgical procedure on the upper aerodigestive tract associated with a code for robotic-assisted surgery. Univariate logistic regression was used to explore factors associated with POH.

RESULTS: Five hundred nine patients underwent TORS. Indications for surgery included neoplastic disease in 376 (74%) and sleep apnea in 74 (15%). Forty-one (8%) had an episode of POH at a median of 9 days postoperatively (range = 0-21 days). Twenty-four (5%) required an intervention related to their POH. Sixteen (3%) required return to the operating room for control of hemorrhage; 11 (2%) had a severe complication that required embolization or tracheostomy. Charlson Comorbidity Score of ≥3 (odds ratio [OR] = 3.02, 95% confidence interval [CI] = 1.45-6.30) and a tonsillar neoplasm (OR = 1.96, 95% CI = 1.03-3.74) were significantly associated with POH.

CONCLUSIONS: The incidence of POH after TORS was low, and few of these patients had a severe complication related to this event. Medical comorbidity and tonsillar subsite may be independent risk factors for POH. These data provide a benchmark for informed decision making in TORS and a basis for further study.

LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2287-2292, 2017.

Author List

Zenga J, Suko J, Kallogjeri D, Pipkorn P, Nussenbaum B, Jackson RS

Author

Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin

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

Female
Humans
Incidence
Length of Stay
Male
Middle Aged
Mouth
Natural Orifice Endoscopic Surgery
Oral Surgical Procedures
Oropharyngeal Neoplasms
Patient Readmission
Postoperative Hemorrhage
Retrospective Studies
Risk Assessment
Robotic Surgical Procedures
United States