Risk factors for postoperative complications in oral cancer and their prognostic implications

Background: The surgical treatment of head and neck cancer call be limited by the risk of postoperative complications. Early identification of risk fa ctors based on clinical characteristics may assist therapeutic planning. Objectives: To identify risk factors for these complications and to evaluat e their prognostic significance. Methods:The medical records of 110 patients with oral squamous cell carcino ma admitted from January 1, 1990, to December 31, 1994, who undenvent radic al surgery were reviewed. Data collected included demographic information, comorbidities, extended clinical severity stage, treatment, complications, and survival. The chi (2) test was used to verify the association between t he variables. Survival analysis was performed with the Kaplan-Meier method. Logistic and Cox proportional hazards regression were used to build models with independent predictive factors for the risk of complications and deat h, respectively. Results: The overall complication rate was 50%. Dehiscence and infection ra tes were 20.9% and 22.7%, respectively. The death rate was 3.6%, Forty-seve n patients (42.7%) were electively referred to the intensive care unit (ICU ). The occurrence of postoperative,complications was associated with extend ed clinical severity stage (P = .02), type of surgery (P = .03), ICU (P = . 03), type of reconstruction (P = .02), Functional Severity Index (P = .03), neck dissection (P = .002), and APACHE II (Acute Physiology and Chronic He alth Evaluation II) (P = .008). The number of complications was significant ly correlated with the length of hospital stay (r=0.24, P=.01) and. with th e Functional Severity Index (r=0.19, P=.03). Five-year overall survival was affected by the type of complications (none, 41.7%; local, 34.1%; and loca l plus systemic, 0% [P < .001]), ICU (no, 46.3%; yes, 20.7% [P=.001]), and extended clinical severity stage (stage 1, 75.6%; stage 2, 50%, stage 3, 28 .6%; and stage 4, 10.2% [P < .001]). In a multivariate analysis bilateral n eck dissection (relative risk=3.57, P=.01) and an APACHE II score greater t han 10 (relative risk=3.86, P=.02) were independent risk factors for compli cations. The predictive prognostic model consisted of the following. stayin g in the ICU (hazard ratio = 1.83), local plus systemic complications (haza rd ratio = 6.27), and extended clinical severity stage (stage 3, hazard rat io =3.57, stage 4, hazard ratio = 6.34). Conclusions: Bilateral neck dissection and the APACHE II score were identif ied as risk factors for postoperative complications in oral cancer, which a lso increase the length of hospital stay. The occurrence of systemic compli cations, advanced extended clinical severity stage, and staying in an ICU a dversely affect the prognosis. Therefore, the prompt recognition of the adv erse risk factors for postoperative complications may guide proactive inter ventions that may improve survival and achieve cost-effectiveness.