K. Kim1, A. Ibrahim1,2, P. Koolen1, N. Seyidova3, S. Lin1,2 1Beth Israel Deaconess Medical Center,Division Of Plastic Surgery,Boston, MA, USA 2Beth Israel Deaconess Medical Center,Division Of Otolaryngology-Head And Neck Surgery,Boston, MA, USA 3Medical University Of Vienna,Vienna, , Austria
Introduction:
The primary aims of reconstructive surgery following resection of skull base tumors are 1) separation of the central nervous system from the aerodigestive tract, 2) reestablishment of orbital and oral cavities, and 3) restoration of the 3-dimensional appearance of bony and soft tissues.Numerous reconstruction methods have been employed and their pros and cons examined. Developments in surgical technique have made it possible to operate on lesions that were previously deemed inoperable. However, despite these technical advancements in addition to improved preoperative radiographic assessment of tumor extent and postoperative care, complications remain an inherent problem in this patient population.
Methods:
We reviewed the 2005-2012 ACS-NSQIP databases to identify patients undergoing skull base surgery. Bivariate analysis was done to compare preoperative variables and postoperative outcomes between the reconstruction group and non-reconstruction group. Chi-square tests were used for categorical variables and t-tests for continuous variables. The odds ratio of respective reconstruction methods was determined to assess their impact on postoperative complications. Multiple logistic regression analysis predicted the influence of preoperative and operative variables on postoperative outcomes.
Results:
479 patients were included in our study; 199 patients received concurrent reconstruction. There was no statistically significant difference in wound complication, morbidity, length of total hospital stay and mortality between the two groups. The reconstruction cohort showed significantly longer operative times (416.45 ±207.585 minutes vs. 319.99 ±222.813 minutes, P=0.001) and higher return to the operating room rate (13.6% vs. 6.1%, P=0.005). Reconstruction using pedicled flap is associated with increased odds of wound complications (OR=4.937, P=0.023), and microsurgical reconstruction with return to the operating room (OR=2.212, P=0.015). Logistic regression implicated dyspnea, diabetes mellitus, functional status and tumor involving central nervous system as predictors for complications in our patient population.
Conclusion:
This is the first comprehensive analysis of reconstruction following skull base surgery using the ACS-NSQIP registry. Additional measures involved in flap reconstruction are associated with an increase in operation time and return to OR rate but not postoperative complications, morbidity, and mortality.
