Comparison of Different Surgical Specialties Performing Ablative Resection and Reconstruction of Cutaneous Malignancies of the Head and Neck in 1,901 Patients

Abstract

PURPOSE: Despite continued advocacy for primary prevention, skin cancer remains the most common malignancy within the United States. With an aging population, the rising incidence of cutaneous malignancies of the head and neck (H&N) poses a challenge to healthcare availability and confronts traditions within the current practice of plastic surgery (PS). Surgical management of cutaneous H&N malignancies is currently performed by a diverse number of surgical specialists. The objective of this study was to assess postoperative outcomes of excision and reconstruction of cutaneous H&N malignancies by these different specialists. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (2005–2017) was queried by International Statistical Classification of Disease and Current Procedural Terminology codes for patients with H&N skin cancer who underwent excision and reconstruction by a single operative specialist. The modified frailty index, an aggregate of 5 National Surgical Quality Improvement Program comorbidities, was utilized to assess patient well-being and as a validated predictor of postoperative morbidity and mortality. Rates of 30-day postoperative complications were compared. Multivariable regression analysis controlling for operative time, reconstructive modality, disseminated cancer, and bleeding disorders was employed to generate adjusted odds ratios. RESULTS: In total, 1,901 patients underwent excision and reconstruction of cutaneous malignancies. Patients (55.7%; n = 1,059) were operated on by PS, whereas 28.3% (n = 538) and 16.0% (n = 304) were operated on by otolaryngology (ENT) and general surgery, respectively. Reconstructive modalities statistically differed between specialties, with PS and ENT performing a greater number of flap reconstructions and tissue rearrangements. Rates of all-cause complications were statistically different, with 2.8% (n = 30) of PS, 6.7% (n = 36) of ENT, and 3.6% (n = 11) of general surgery patients experiencing ≥1 all-cause complication (P < 0.001). There was a positive correlation between ENT patients and all-cause complications compared with PS patients on univariate analysis (odds ratio, 2.460; P < 0.001); however, this outcome did not persist in multivariate analysis (odds ratio, 1.674; P = 0.076). Multivariate analysis further demonstrated that smoking, steroid use, and frailty indices of 2 and ≥3 were all-cause complication predictors. CONCLUSION: The incidence of complications following resection and reconstruction of H&N cutaneous malignancies is relatively low. This study supports the involvement of plastic surgeons in management of cutaneous H&N malignancies.