Predictors of surgical complications in patients with sinonasal malignancy

Abstract

Objectives Sinonasal and skull base tumors are rare, making it difficult to identify trends in surgical outcome. This study examines complications in a large cohort of patients undergoing surgery for sinonasal malignancy. Methods Following IRB approval, an institutional database was reviewed to identify patients who underwent surgery for sinonasal or skull base malignancies from 1973 to 2016 at our institution. Charlson comorbidity index score and Clavien–Dindo grade were calculated. The main study endpoint was subgroup analysis of Clavien–Dindo Grade 0, Grades 1–2, and Grades 3–5 complications. An ordinal logistic regression model was constructed to assess the association between comorbidities, demographics, tumor characteristics, and surgical complications. Results In total, 448 patients met inclusion criteria. Perioperative mortality rate at 30 days was 1.6% (n = 7). The rate of severe complications (Clavien–Dindo 3 or higher) was 13.6% (n = 61). Multivariate analysis using an ordinal logistic regression model showed no association between Charlson comorbidity index score and Clavien–Dindo grade of postoperative complication. Advanced T‐stage was significantly associated with complications (p = 0.0014; odds ratio: 3.442 [95% confidence interval: 1.615, 7.338]). Conclusion Surgery for sinonasal and skull base tumors is safe with a low mortality rate. Advanced T‐stage is associated with postoperative complications. These findings have implications for preoperative risk stratification. Key Points Surgery for sinonasal malignancy is safe with a 30 mortality of 1.6% and rate of severe complications of 12.8%. There is no association between patient comorbidity and post operative complication. On multivariate analysis, only advanced T stage was associated with increased rate of surgical complication.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…Age, sex, ethnicity, and socioeconomic status, as well as tobacco and alcohol use, were not associated with a higher risk of surgical complications in some series 14,2054 . On the other hand, a large retrospective cohort found a positive association between the presence of comorbidities and surgical complications, but the severity of comorbidities was not rated 2056 .…”

“…found a 36% rate of acute postoperative complications and 5% mortality after open CFR 2056 . A recent single‐institution study of primarily open surgery for SNM revealed a 14% rate of Clavien–Dindo complication (grade ≥3) and 30‐day mortality rate of 2% 2054 . Gray et al.…”

“…Surgery is part of the standard treatment for sinonasal tumors and is also an option for salvage in cases of recurrence. The most common surgical complications encountered during sinonasal tumor surgery include bleeding, infection, CSF leak, meningitis, diplopia and other visual disturbance, orbital and intracranial injury, ORN, and secondary CRS 14,68,313,2054 . Most studies involving sinonasal tumors and its treatment outcomes are retrospective.…”

“…Another review analyzed demographic and patient factors in patients undergoing surgery for SNM. They used the Charlson comorbidity index to stratify preoperative comorbidities and Clavien–Dindo grade to specify the level of complications, and no statistical association was found between these variables 2054 . Bashjawish et al.…”

“…With advancements in surgical technique and multidisciplinary interventions, greater focus has been placed on optimizing posttreatment QOL and minimizing morbidity while maximizing survival (Table XXXI.B.1). 1513,2054 Patients with SNM can present with variable symptoms, including epistaxis, nasal obstruction, rhinorrhea, seizures, orbital pathology, cranial nerve palsies, and headaches, among others 267,2097,2098,2100 . Overall, QOL research is limited by the fact that the questionnaires typically used are validated for clinical conditions other than SNM specifically 2085,2090,2093,2101–2103 .…”