Preoperative laboratory data are associated with complications and surgical site infection in composite head and neck surgical resections

Am J Otolaryngol. May-Jun 2018;39(3):261-265. doi: 10.1016/j.amjoto.2018.01.017. Epub 2018 Jan 31.

Abstract

Objectives: 1) Describe normal/abnormal preoperative laboratory testing incidence in head and neck (H&N) composite resections and 2) determine complication, surgical site infection (SSI), and transfusion predictors by laboratory test.

Methods: The 2006 to 2013 NSQIP databases were queried for H&N composite resections. Laboratory data was categorized within, under, or above the normal reference range according to NSQIP definitions. Overall complications and SSI were analyzed with multivariable logistic regression analysis.

Results: From 2006 to 2013, there were 1193H&N composite resections, of which 1135 (95.1%) underwent ≥1 preoperative laboratory test. Complete blood counts were obtained in 92.3%, basic metabolic panels in 90.7%, coagulation studies in 56.2%, and liver function tests (LFTs) in 52.6%. Low sodium was found in 11.5%, increasing complication odds by 2.30 (p = 0.005). High AST comprised 10.0% and increased complication odds (OR = 2.93, p = 0.012). Additionally, 9.2% had a high white blood cell (WBC) count and 3.5% had high platelets, increasing complications by 1.92 (p = 0.030) and 3.13 (p = 0.015), respectively. BUN, creatinine, total bilirubin, albumin, alkaline phosphatase, INR, PT, and aPTT abnormal values did not affect postoperative complications. Increased SSI odds were appreciated with low sodium (OR: 2.83, p = 0.002), high AST (OR: 6.85, p < 0.001), and high alkaline phosphatase (OR: 5.46, p = 0.007). Importantly, INR had no effect on transfusion rates. High PT, aPTT, or low platelets did not change transfusion odds.

Conclusion: Inflammatory markers are associated with complications but not SSI. High LFTs and low sodium are associated with complications and SSI. Coagulopathies did not increase transfusion rates. These findings identify laboratory studies to focus on during H&N resection preoperative assessments.

Keywords: Complications; Head and neck; Inflammatory; Laboratory; Liver function test; Markers; Otolaryngology; Surgical site infection; Transfusion; White blood count.

MeSH terms

  • Age Factors
  • Aged
  • Blood Chemical Analysis
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery*
  • Cohort Studies
  • Databases, Factual
  • Disease-Free Survival
  • Female
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Kidney Function Tests
  • Liver Function Tests
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neck Dissection / adverse effects
  • Neck Dissection / methods
  • Otorhinolaryngologic Surgical Procedures / adverse effects*
  • Otorhinolaryngologic Surgical Procedures / methods
  • Predictive Value of Tests
  • Preoperative Care / methods*
  • Prognosis
  • Reoperation / methods
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Surgical Wound Infection / diagnosis*
  • Surgical Wound Infection / epidemiology
  • Survival Analysis
  • Treatment Outcome