Role of reconstructive surgery in the management of XXXX : A national outcomes analysis of 11,841 reconstructions.

@entity5 @entity135 @entity1
BACKGROUND: The quality of @entity135 reconstruction in England is not known. Hospital administrative data provides details of treatment within the English National Health Service and may be used for national outcomes analysis. METHODS: An algorithm for identifying head and neck surgery with flap-based reconstruction from administrative data was constructed and validated against information from three @entity5 units. The validated algorithm was applied to 2003-2013 national activity. RESULTS: The algorithm was 91% sensitive and over 99% specific. Its application to administrative data identified 11,841 @entity1 and demonstrated an increase of 52% in reconstruction-containing @entity135 surgery in the past decade. There were 7776 males and mean treatment age was 62 years. Oral cavity was the commonest primary site (n  =  7567; 64%) and 7575 @entity1 (64%) underwent primary surgery. The commonest procedure was floor-of-mouth excision (n  =  3614) and 9749 @entity1 had a neck dissection. The most commonly used flap was the radial forearm (n  =  4429). Flap failure occurred in 496 (4.2%) @entity1 . It increased the mean length of stay from 22 to 41 days (P  <  0.00001), and the odds ratio of in-hospital death to 2.37 [95% confidence interval 1.66-3.38; P  <  0.0001]. Lethality of reconstructive failure was not uniform and was highest when a pharyngolaryngeal flap failed. CONCLUSIONS: Reconstructive surgery is central to the multidisciplinary management of @entity135 . Its quality directly influences @entity1 morbidity and survival. We recommend that analysis of hospital administrative data should be periodically carried out as part of an over-arching quality assurance programme and, particularly for pharyngolaryngeal reconstructions, surgery should be undertaken in units with the best reconstructive outcomes.
