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NEW YORK (Reuters Health) – A new preoperative risk index can help predict short-term adverse events (AEs) following surgery for head and neck cancer, according to Canadian researchers.

Surgical resection and radiotherapy are the mainstays of treatment for this type of malignancy, but as many as 40% of patients experience postoperative AEs, the team notes in JAMA Otolaryngology-Head & Neck Surgery, online February 21.

To develop a preoperative risk index of short-term major postoperative AEs, Dr. Nancy Mayo and colleagues at McGill University, in Montreal, analyzed data on more than 31,000 patients who underwent inpatient ablative or reconstructive surgery for head and neck cancer between 2006 and 2016. Half were randomly assigned to a derivation cohort and the remainder to a validation cohort.

Within the first 30 days of surgery, 14.5% patients had a major AE, and 0.7% died.

Using the derivation cohort, the researchers developed a prediction model involving 16 factors – such as age, hypertension, anemia, wound classification and hypoalbuminemia – that were independently associated with major AEs or death on multiple regression analysis.

In the validation cohort, the head-and-neck-surgery risk index (HNSRI) had a sensitivity of 80.1% and specificity of 72.3%. The index outperformed existing models, the researchers say, including the American Society of Anesthesiologists classification and the American College of Surgeons risk calculator.

The team points to a number of limitations, including the fact that patients who died had significantly different preoperative characteristics than those who survived, suggesting that they might represent a different population.

Nevertheless, given its sensitivity and specificity, they conclude that the HNSRI “can be used to counsel patients awaiting head and neck cancer surgery.”

Dr. Mayo did not respond to requests for comments.


JAMA Otolaryngol Head Neck Surg 2019.

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