A national overview of surgical misadventures in head and neck surgery: "Oh No, You Cut It".
A national overview of surgical misadventures in head and neck surgery: "Oh No, You Cut It".
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全国头颈外科手术事故概述：“哦，不，你剪掉了”。
DOI：
10.1002/lary.28035
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Kandil,Emad
中科院分区：
文献类型：
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作者：
Al-Qurayshi,Zaid;Randolph,Gregory;Walsh,Jarrett;Owen,Scott;Kandil,Emad
目的/假设研究头颈部手术中报告的术中意外损伤的风险和患病率以及相关结局。研究设计回顾性横断面分析。方法利用2010年至2014年全国再入院数据库进行分析。成人患者报告意外术中损伤进行了比较，对照组没有这样的injurising.ResultsA共173例和105,659对照组。报告的病例主要发生在口腔/扁桃体（29.4%）和颌面骨/下颌骨（22.5%）手术中。其余病例报告在咽/喉（17.5%）、鼻/鼻窦（15.4%）、唾液腺和导管（6.2%）、甲状腺/甲状旁腺（5.2%）和耳（3.8%）手术中。多变量logistic回归模型显示，咽/喉手术与其他部位手术相比，损伤风险最高（比值比[OR]：2.51，95%可信区间[CI]：1.49，4.25，P <.001）。颈淋巴清扫术也与损伤风险独立相关（OR：4.07，95%CI：2.05，8.09，P <.001）。与对照组相比，病例与死亡风险增加无关（P =.63）或再入院（P =.29）;平均住院时间延长3.64 ± 0.95天/例（P <0.001），平均治疗费用增加13，478 ± 119.42美元/例（P <0.001）。患病率相对较低，且年趋势似乎稳定;然而，它与卫生系统的重大负担相关。证据水平NAL喉镜，130：918 - 924，2020
Objectives/HypothesisTo examine the risk and prevalence of accidental intraoperative injury reported during head and neck surgeries and the associated outcomes.Study DesignRetrospective cross‐sectional analysis.MethodsAn analysis utilizing the Nationwide Readmissions Database, 2010 to 2014. Adult patients with a reported accidental intraoperative injury were compared to controls without such injuries.ResultsA total of 173 cases and 105,659 controls were included. Most cases were reported in surgeries of the mouth/tonsils (29.4%) and maxillofacial bones/mandible (22.5%). The remaining cases were reported in surgeries of the pharynx/larynx (17.5%), nose/paranasal sinuses (15.4%), salivary glands and ducts (6.2%), thyroid/parathyroid (5.2%), and ear (3.8%). The multivariate logistic regression model demonstrated that surgeries of the pharynx/larynx were associated with the highest risk of injuries compared to other site surgeries (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.49, 4.25,P< .001]. Concomitant neck dissection was also independently associated with the risk of injury (OR: 4.07, 95% CI: 2.05, 8.09,P< .001]. Compared to controls, cases were not associated with an increased risk of mortality (P= .63) or readmission (P= .29); however, those cases had a significantly longer hospital stay on average by 3.64 ± 0.95 days/case (P< .001) and a higher cost of treatment on average by $13,478 ± 119.42/case (P< .001).ConclusionsThis study reports on the prevalence and outcomes of accidental intraoperative injuries reported in head and neck surgeries. The prevalence is relatively low, and the annual trend appears stable; however, it is associated with a significant burden on the health system.Level of EvidenceNALaryngoscope, 130:918–924, 2020