Outcomes and Risk Factors in Oncologic Temporal Bone Surgery: A Head and Neck-Specific NSQIP Analysis.

Abstract

Advanced temporal bone and parotid gland malignancies are rare and difficult to manage. However, complications of oncologic temporal bone surgery have not been systematically categorized. We aim to detail the postoperative outcomes of lateral temporal bone resection (LTBR) and mastoidectomy for otologic oncology patients, and secondarily, to identify preoperative risk factors. Retrospective cohort study. Tertiary academic center. Patients with temporal bone or parotid gland malignancies treated with LTBR or mastoidectomy at our institution. Demographic, clinical, and 30-day postoperative data was extracted from a head and neck-specific (HNS) NSQIP database. One hundred seventy-four patients underwent LTBR (n = 121) or mastoidectomy (n = 53). Reconstruction was performed in 98%, with 94% being free flaps. Half experienced at least one postoperative occurrence (n = 59/121, LTBR; n = 27/53 mastoidectomy). The most common was anemia requiring blood transfusion (n = 47/174), with nearly double the incidence in LTBR versus mastoidectomy (32.2% vs 15.1%, P = .019). LTBR patients had longer length of stay (mean 7.6 vs 5.5 days), while mastoidectomy had higher rates of facial nerve injury (5.7% vs 1.7%, P > .05). On multivariable analysis, patients with increased age (per decade) (P = .012), higher stage tumors (T3/T4) (P = .048) and lengthy operative time (>13 hours) (P = .015) had significantly increased risk of developing an HNS-NSQIP occurrence. LTBR and mastoidectomy, alongside their reconstruction, are associated with relatively high rates for anemia requiring blood transfusion, new-onset facial paralysis, and extended length of stay. When performing risk assessment and mitigation, age, tumor stage, and operative time should be considered.