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The Annals of Otology, Rhinology, and... Mar 2021Recent literature suggests that outpatient head and neck surgery is safe and may decrease costs. This study assesses whether outpatient parotidectomy differs in...
OBJECTIVES
Recent literature suggests that outpatient head and neck surgery is safe and may decrease costs. This study assesses whether outpatient parotidectomy differs in complication type and rate from inpatient surgery.
METHODS
Patients who underwent parotidectomy at our institution from 2011 to 2019 were retrospectively reviewed and divided by inpatient or outpatient status. Complications including infection, seroma, salivary fistula, hematoma, and flap necrosis, as well as readmission rates were tabulated. Drain placement, related to tumor size, was also analyzed using a receiver operating curve.
RESULTS
144 patients had available data for analysis. Nine of the 144 patients had complications. Seven of 98 outpatients and two of 46 inpatients had complications. There was no statistically significant difference in complication rate between the two groups ( = .518). Tumor size ≥4.62 cm was associated with drain placement ( = .044).
CONCLUSION
Outpatient parotidectomy is a safe and viable alternative for carefully selected patients.
Topics: Adenolymphoma; Adenoma, Pleomorphic; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Carcinoma, Mucoepidermoid; Cohort Studies; Facial Nerve Injuries; Female; Hospitalization; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Parotid Diseases; Parotid Neoplasms; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Salivary Gland Calculi; Salivary Gland Fistula; Seroma; Surgical Flaps; Surgical Wound Infection; Young Adult
PubMed: 32672069
DOI: 10.1177/0003489420938101 -
Head & Neck Feb 2017Does the extent of parotidectomy or other patient or tumor characteristics influence the rate of sialocele/salivary fistula formation? (Review)
Review
BACKGROUND
Does the extent of parotidectomy or other patient or tumor characteristics influence the rate of sialocele/salivary fistula formation?
METHODS
All patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013 were considered. Patients who developed a sialocele/salivary fistula were identified. Extent of dissection, age, sex, body mass index (BMI), volume of specimen, and rate of malignancy were examined.
RESULTS
Seventy of 771 patients (9.1%) developed a sialocele/salivary fistula. Sixty-seven fistulae (96%) developed within 1 month and all resolved by 6 months. Age, sex, pathology, and BMI were not increased in the sialocele group. Inferior and middle superficial parotidectomy had a significantly higher rate of sialocele than other extents of dissection. Volume of tissue removed was not significantly different between dissection groups.
CONCLUSION
Sialocele/salivary fistula is common postparotidectomy and is more likely with inferior and middle superficial parotidectomy. © 2016 Wiley Periodicals, Inc. Head Neck 39: 387-391, 2017.
Topics: Adult; Aged; Cohort Studies; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Postoperative Complications; Reoperation; Retrospective Studies; Risk Factors; Salivary Gland Fistula; Treatment Outcome; United States
PubMed: 27550745
DOI: 10.1002/hed.24564 -
World Journal of Otorhinolaryngology -... Jun 2022Parotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative... (Review)
Review
Parotidectomy is the mainstay treatment for tumors of the parotid gland. In an effort to improve clinical outcomes, several modern surgical techniques and perioperative interventions have been evaluated and refined. This review discusses current and actively debated perioperative interventions aimed at improving patient safety and the quality of parotidectomy. Relevant high-impact literature pertaining to preoperative diagnostic modalities, intraoperative surgical techniques, and postoperative care will be described.
PubMed: 35782399
DOI: 10.1002/wjo2.50 -
Head & Neck Sep 2019To investigate the feasibility of an endoscopic-assisted postauricular-groove approach parotidectomy and to evaluate the advantages and limitations of such an approach. (Comparative Study)
Comparative Study
BACKGROUND
To investigate the feasibility of an endoscopic-assisted postauricular-groove approach parotidectomy and to evaluate the advantages and limitations of such an approach.
METHODS
A total of 72 patients with parotid gland tumors underwent a parotidectomy procedure between January 2014 and January 2016. Of the aforementioned patients, 15 were treated by a postauricular-groove approach (group I), whereas the remaining 57 were treated by the Blair "S" incision (group II).
RESULTS
Difference in visual analogue scale score for aesthetic outcome (0 vs 3) and median intraoperative blood loss (30 vs 50 mL) was statistically significant. Operation time and transient facial nerve paralysis were comparable. No recurrence of tumors was found in either group.
CONCLUSION
The endoscopic-assisted postauricular-groove approach for limited parotid tumor resection offers several advantages over the conventional "S" incision parotidectomy. In addition, it is arguably safer and results in a superior aesthetic outcome.
Topics: Blood Loss, Surgical; Endoscopy; Esthetics; Facial Paralysis; Feasibility Studies; Female; Humans; Male; Middle Aged; Operative Time; Parotid Gland; Parotid Neoplasms; Patient Satisfaction; Postoperative Complications; Visual Analog Scale
PubMed: 30869186
DOI: 10.1002/hed.25720 -
Otolaryngologic Clinics of North America Apr 2016Parotidectomy is a commonly performed procedure for both benign and malignant lesions. When a significant portion of the gland is resected and the lost tissue volume is... (Review)
Review
Parotidectomy is a commonly performed procedure for both benign and malignant lesions. When a significant portion of the gland is resected and the lost tissue volume is not replaced, a disfiguring contour defect can result. This defect can be disfiguring and have a profound impact on quality of life. Large defects are best replaced with vascularized tissue to provide stable volume.
Topics: Humans; Parotid Neoplasms; Quality of Life; Plastic Surgery Procedures; Surgical Flaps
PubMed: 27040588
DOI: 10.1016/j.otc.2015.10.008 -
Journal of Oral and Maxillofacial... Nov 2018Given the increasing costs of medical care, there has been a shift to outpatient elective surgeries in certain patient populations among all surgical specialties. The...
PURPOSE
Given the increasing costs of medical care, there has been a shift to outpatient elective surgeries in certain patient populations among all surgical specialties. The goal of this study was to compare the safety and efficacy of outpatient parotidectomy with traditional inpatient parotidectomy.
MATERIALS AND METHODS
This is a retrospective chart review of all patients who underwent a parotidectomy at a single tertiary academic center from 2007 through 2017.
RESULTS
There were 568 patients who met the inclusion criteria. There was no difference in demographics or patient comorbidities between the inpatient and outpatient groups. There was no increased incidence of postoperative complications or extent of postoperative care in patients who underwent outpatient parotidectomy. On average at the authors' institution, the direct outpatient parotidectomy cost was $1,200 less than the inpatient equivalent.
CONCLUSION
Outpatient parotidectomy can be performed safely and cost effectively with no increased risk of complications.
Topics: Adult; Ambulatory Surgical Procedures; Female; Hospital Charges; Humans; Male; Otorhinolaryngologic Surgical Procedures; Parotid Diseases; Patient Safety; Postoperative Complications; Retrospective Studies; Treatment Outcome; United States
PubMed: 29792835
DOI: 10.1016/j.joms.2018.04.032 -
Indian Journal of Otolaryngology and... Oct 2019Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenoma is the most common salivary gland tumor, accounting...
Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenoma is the most common salivary gland tumor, accounting for 60-80% of benign tumors of salivary glands, which predominantly affect the superficial lobe of the parotid gland. The "pleomorphic" nature of the tumor can be explained on the basis of its epithelial and connective tissue origin. Usually they are found as solitary unilateral, firm and mobile, painless, slow growing mass. The tumor has a female predilection between 30 and 50 years of age. Utmost care is to be taken to preserve the facial nerve while performing superficial or total parotidectomy. We present 10 cases of pleomorphic adenoma of parotid gland over period of 2 years, highlighting the prognosis following surgical management.
PubMed: 31741967
DOI: 10.1007/s12070-018-1245-3 -
The Journal of Craniofacial Surgery Jan 2019Multiple specialties have demonstrated increased risk of certain postoperative complications in patients with an increased body mass index (BMI). The goal of this study...
Multiple specialties have demonstrated increased risk of certain postoperative complications in patients with an increased body mass index (BMI). The goal of this study was to understand the outcomes of patients undergoing parotidectomy with an increased BMI and to identify any other patient risk factors for postoperative complications. This study was a retrospective chart review of 432 patients. Patient variables collected included BMI, age, gender, history of diabetes mellitus, type of parotidectomy, and pathology. Outcomes reviewed included facial nerve weakness, hematoma or seroma formation, and wound infection. The results showed that BMI had no statistically significant effect on complications. However, patients undergoing a total parotidectomy, malignant pathology, and patients with a history of diabetes mellitus had significantly more postoperative facial weakness. In conclusion, BMI does not influence postoperative complications in patients undergoing parotidectomy. Patients with diabetes, those undergoing total parotidectomies, and patients with malignant pathology have significantly more facial weakness and should be counseled accordingly.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Body Mass Index; Child; Diabetes Mellitus; Facial Paralysis; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Postoperative Complications; Retrospective Studies; Risk Factors; Young Adult
PubMed: 30444765
DOI: 10.1097/SCS.0000000000004973 -
Journal of Otolaryngology - Head & Neck... Nov 2019Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction...
BACKGROUND
Parotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy.
METHODS
A retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events.
RESULTS
There were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation.
CONCLUSIONS
There are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.
Topics: Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Middle Aged; Parotid Neoplasms; Patient Readmission; Postoperative Complications; Plastic Surgery Procedures; Reoperation; Retrospective Studies; United States
PubMed: 31744535
DOI: 10.1186/s40463-019-0387-y -
American Journal of Otolaryngology 2023Parotidectomies have historically been performed on an inpatient basis despite being well-tolerated surgeries with minimal postoperative wound care and low rates of...
BACKGROUND
Parotidectomies have historically been performed on an inpatient basis despite being well-tolerated surgeries with minimal postoperative wound care and low rates of complications at high-volume institutions. Past studies have supported the safety of outpatient surgery for parotidectomy but have been limited to superficial parotidectomy and have not addressed the patient experience surrounding the surgical intervention such as pre-operative and post-operative care and communication.
PURPOSE
This study assesses the impact of outpatient superficial, deep, and partial parotid surgery on various parameters including surgical safety, distance traveled for care, utilization of telehealth, and patient-initiated communication.
MATERIALS AND METHODS
Retrospective study from January 2020 to October 2021. Patients undergoing superficial lobe, deep lobe, and partial parotidectomies for benign and malignant pathologies were divided into inpatient and outpatient cohorts. A multivariable model examined the relationship between admission status and surgical complications, adjusted for age, sex, and tumor size.
RESULTS
159 patients total, 94 outpatient and 65 inpatients. No statistical difference in rates of surgical complications with the exception of salivary leak. There was an increased rate of salivary leak reported in the inpatient group (OR 5.4, 95 % CI 1.6 to 18.0, p = 0.01). Mean patient travel distance of 354 miles one-way. Post-operatively, 76 % were evaluated via video visit. Following discharge, >55 % of patients initiated communication with the surgical team, which was not statistically different between the groups.
CONCLUSIONS
Outpatient parotidectomy is safe and can be more convenient, but telehealth communication must be balanced with rigorous attention to patient education.
Topics: Humans; Parotid Neoplasms; Outpatients; Retrospective Studies; Postoperative Complications; Salivary Glands; Parotid Gland
PubMed: 36842422
DOI: 10.1016/j.amjoto.2023.103806