Impact of Dementia on the Postoperative Outcomes in Patients Undergoing Surgery for Head and Neck Cancers: A National Study
Rema Anisha Kandula, Grant Borne, Sandeep Kandregula, Robbie Beyl, Cherie‐Ann O. Nathan- Otorhinolaryngology
Background
Dementia, a growing concern among the elderly, has an increased poor postoperative outcome that goes unrecognized by many. Our study aims to establish if dementia plays a role in the outcomes of head and neck cancer patients that undergo resections.
Methods
We queried the National Inpatient Sample (NIS) database from 2016 to 2019 with a primary diagnosis of head and neck cancer who underwent surgical resection. Outcomes analyzed include postoperative delirium, ICU stay, complications, length of stay, and non‐routine discharge.
Results
A total of 77095 patients were included, of which 1140 patients had dementia. The mean age of the patients with dementia was 77.5 years (±9.1) versus 63.2 years (±12.1) with no dementia. Dementia patients had a higher non‐home discharge rate (77.2% vs 46.8%, p = <0.001), extended length of stay (10.9 days ±14.7 vs 7.9 days ±8.8), postoperative delirium (15.4% vs 1.5%, p = <0.001), and longer ICU stay (8.3% vs 5.8%) as compared with patients with no dementia. A higher number of patients with Dementia were placed in long‐term facilities (53.5% vs 14.6%) postoperatively. More dementia patients (7.9% vs 0.9%) were transferred in from another health care facility for surgery. Dementia was associated with higher odds of delirium (OR, 6.36; 95% CI, 5.2–7.77), non‐routine discharge (OR, 2.05; 95% CI, 1.76–2.3), ventilation (OR, 0.8; 95% CI, 0.6–1.05), and length of stay (estimate 3.01, 95% CI, 1.84–4.184).
Conclusion
Preoperative dementia significantly impacts postoperative delirium, non‐home discharge, and extended length of stay in head and neck cancer patients undergoing surgery.
Level of Evidence
3 Laryngoscope, 2023