Social Determinants of Health Impact Complications Following Free-Flap Reconstruction for Head and Neck Cancer.

IF 2.6 3区医学 Q1 OTORHINOLARYNGOLOGY Otolaryngology- Head and Neck Surgery Pub Date : 2024-08-27 DOI:10.1002/ohn.953

Zachary N Goldberg, Amiti Jain, Richard Wu, David M Cognetti, Richard A Goldman

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Abstract

Objective: Head and neck cancers (HNCs) have increased in prevalence and often require free-flap reconstruction (FFR) after tumor ablation. Postoperative complications following FFR can be high, occurring in as many as 48% and 71% of cases. HNC patients also have many disparities in Social Determinants of Health (SDOH), but the potential impact of SDOH disparities on postoperative complications following FFR has not been formally assessed.

Study design: Retrospective cohort review.

Setting: Academic Tertiary Care Institution in Northeast United States.

Methods: Patients that underwent head and neck FFR between January 2018 and December 2021 were analyzed to determine associations between quartiles of the national Area Deprivation Index (ADI), a proxy for SDOH disparity, and various medical and surgical postoperative complications. Associations were assessed using χ² analysis.

Results: Two hundred four patients were included in the study, and 61 patients had 97 complications. Significant associations between higher national ADI quartile and incidence of several postoperative complications were identified, including any surgical complication (P = .0419), wound dehiscence (P = .0494), myocardial infarction (MI) (P = .0215), and sepsis (P = .0464).

Conclusion: There are significant associations between SDOH disparities and postoperative surgical complications, wound dehiscence, MI, and sepsis following head and neck FFR. Addressing SDOH disparities in HNC is pivotal to enhance postoperative outcomes and promote holistic patient care.

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影响头颈部癌症游离瓣重建术后并发症的健康社会决定因素。

目的：头颈部癌症（HNC）的发病率越来越高，肿瘤消融术后往往需要进行游离瓣重建（FFR）。FFR 术后并发症可能很高，发生率分别高达 48% 和 71%。HNC患者在社会健康决定因素（SDOH）方面也存在许多差异，但SDOH差异对FFR术后并发症的潜在影响尚未得到正式评估：研究设计：回顾性队列回顾：研究设计：回顾性队列回顾：对2018年1月至2021年12月期间接受头颈部FFR手术的患者进行分析，以确定国家地区贫困指数（ADI）四分位数（SDOH差异的代表）与各种内外科术后并发症之间的关联。相关性采用χ2分析法进行评估：研究共纳入了 24 名患者，其中 61 名患者出现了 97 种并发症。发现全国 ADI 四分位数越高与几种术后并发症的发生率之间存在显著关联，包括任何手术并发症（P = .0419）、伤口裂开（P = .0494）、心肌梗死（MI）（P = .0215）和败血症（P = .0464）：结论：SDOH差异与头颈部FFR术后手术并发症、伤口开裂、心肌梗死和败血症之间存在明显关联。解决 HNC 中的 SDOH 差异对提高术后效果和促进患者整体护理至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Otolaryngology- Head and Neck Surgery 医学-耳鼻喉科学

CiteScore

6.70

自引率

2.90%

发文量

250

审稿时长

2-4 weeks

期刊介绍： Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.