30-Day outcomes analysis of NSQIP-pediatric for surgical management of head and neck lymphatic malformations in children

Abstract

ObjectiveIdentify adverse events associated with surgical management of head and neck lymphatic malformations in children by investigating a US national database. Data sourcePediatric American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® - pediatric), years 2012–2016. MethodsSubjects included children under 18 years with a postoperative diagnosis of International Classification of Diseases (ICD), 9 th revision code: 228.1 – lymphangioma, any site or ICD-10 code D18.1. Results163 patients were identified. 67 (41.1%) were female and 96 (58.9%) were male. The median age was 4.2 years (interquartile range [IQR] 1.6–11.3 years). Sixty-five (39.9%) underwent head and neck procedures. 19 (11.7%) patients with 30-day adverse events were identified, with unplanned reoperation being the most common; in the head and neck surgery group, there were 5 (7.7%). There was no significant difference in the occurrence of adverse events between head and neck surgery and the non-head and neck surgery group (p = 0.2238). ConclusionsNo individual patient clinical factors were identified to be associated with increased rates of 30-day adverse event rates for surgical management of lymphatic malformations in children. Our investigation highlights the need for quality improvement to help decrease 30-day adverse events for surgery for this group, as the rate was quite high overall (11.7%). The wound complication rate was very low, but we observed a non-negligible number of reoperations and readmissions. Improving quality of care for surgical management of lymphatic malformations in children should focus future investigations on limiting reoperations and readmissions within the first 30 days postoperatively.