2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Fig. 3. Primary outcome rate of abscess-specific morbidity and mor- tality by timing of surgery. * P < 0.05.

ing of surgery and postoperative M&M was not observed. However, congenital heart disease (OR 12.77, 95% CI 1.12–145.8) and ASA class III–IV (OR 5.59, CI 2.04–15.34) were significant predictors of abscess-specific M&M. Group definitions for sensitivity analyses of surgical timing were then modified, as described above (Table IV).

(Table III). In adults, delay in surgical drainage nonsigni- ficantly increased M&M for those who received surgery 1 to 2 days after admission (OR 1.27, 95% CI 0.59–2.74) and significantly increased the rate for those who received sur- gery 3 to 7 days after admission (OR 2.38, 95% CI 1.01– 5.59). In pediatric patients, the association between tim-

TABLE II. Unadjusted Rate of Morbidity and Mortality Based on Timing of Operative Drainage.

Pediatrics

Adults

0 days 1–2 days 3–7 days

P value 0 days 1–2 days 3–7 days

P Value

n (%)

n (%)

n (%)

n (%)

n (%)

n (%)

(n 5 282)

(n 5 299)

(n 5 84)

(n 5 191)

(n 5 104)

(n 5 52)

Abscess specific morbidity and mortality

15 (5.3)

12 (4.0)

4 (4.8)

0.68 22 (11.5)

15 (14.4)

13 (25.0)

0.02

Sepsis

0 (0)

0 (0)

< 5*

0.13

< 5*

5 (4.8)

< 5* < 5* < 5*

0.35

Septic shock

0 (0)

0 (0)

0 (0) 0 (0)

–

6 (3.1)

7 (6.7)

0.02

Deep surgical-site infection

< 5*

< 5* < 5*

0.18 7 (3.7)

< 5* < 5* < 5*

1

Organ space surgical-site infection

0 (0)

< 5*

0.1

< 5* < 5*

0 (0)

1

Pneumonia

0 (0)

0 (0)

< *

0.13

< 5*

0.49 0.01

Unplanned intubation or prolonged ventilation 12 (4.3)

10 (3.3)

2 (2.4)

0.38 13 (6.8)

3 (2.9)

5 (9.6)

Mortality

0 (0)

0 (0)

0 (0)

–

0 (0)

< 5*

< 5*

0.2

Neurologic complications Peripheral nerve injury

0 (0)

0 (0)

0 (0)

–

< 5*

0 (0)

0 (0)

1

Stroke or coma > 24 hours

0 (0)

0 (0)

0 (0)

–

0 (0)

0 (0)

< 5*

0.06

Seizure or intraventricular hemorrhage

0 (0)

0 (0)

0 (0)

–

–

–

–

–

Other complications Superficial SSI

< 5*

0 (0)

0 (0)

0.07

< 5*

< 5* < 5*

0 (0)

1

Return to surgery

11 (3.9)

12 (4)

< 5*

0.94 13 (6.8)

5 (9.6)

0.18

Length of stay Days from admission to surgery, median (IQR)

0 (0)

1 (1)

3 (1)

< 0.001 0 (0)

1 (1)

3 (2)

< 0.001 < 0.001 < 0.001 < 0.001

Days from surgery to discharge, median (IQR)

2 (2) 2 (2)

2 (2) 3 (2)

3 (2) 6 (2)

0.54 2 (4)

3 (3) 4 (4)

4 (11) 8 (12)

Total length of stay, median (IQR)

< 0.001 2 (4)

Length of stay 7 days

13 (4.6)

13 (4.4)

29 (34.5)

< 0.001 26 (13.6)

27 (26.0)

33 (64.7)

Cell size n < 5 are masked with an * to protect patient privacy unless the event was a composite outcome. Septic shock data missing from the Ameri- can College of Surgeons National Surgical Quality Improvement Program Pediatrics for 2012 and only recorded as sepsis. IQR 5 interquartile range; SSI 5 surgical site infection.

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