Outcomes after definitive surgery for mandibular osteoradionecrosis

Kevin J. Contrera; Steven B. Chinn; Randal S. Weber; Dianna Roberts; Jeffery N. Myers; Stephen Y. Lai; Carol M. Lewis; Amy C. Hessel; Ann M. Gillenwater; Collin F. Mulcahy; Peirong Yu; Matthew M. Hanasono; Clifton D. Fuller; Mark S. Chambers; Mark E. Zafereo

doi:10.1002/hed.27024

Outcomes after definitive surgery for mandibular osteoradionecrosis

Kevin J. Contrera, Steven B. Chinn, Randal S. Weber, Dianna Roberts, Jeffery N. Myers, Stephen Y. Lai, Carol M. Lewis, Amy C. Hessel, Ann M. Gillenwater, Collin F. Mulcahy, Peirong Yu, Matthew M. Hanasono, Clifton D. Fuller, Mark S. Chambers, Mark E. Zafereo

Houston Methodist

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Objectives: To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). Materials and Methods: Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. Results: Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01–19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19–30.29) and smoking (OR 5.91, 95% CI 1.69–20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16–12.17) and preoperative swallow (OR 3.42, 95% CI 1.23–9.51). Five-year ORN-recurrence-free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43–8.94). Conclusions: Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.

Original language	English (US)
Pages (from-to)	1313-1323
Number of pages	11
Journal	Head and Neck
Volume	44
Issue number	6
DOIs	https://doi.org/10.1002/hed.27024
State	Published - Jun 2022

Keywords

hospital charges
mandibular
osteoradionecrosis
outcomes
survival

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/hed.27024

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@article{302bdb9a6a0a43109b0a14d4c5b0d1d4,

title = "Outcomes after definitive surgery for mandibular osteoradionecrosis",

abstract = "Objectives: To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). Materials and Methods: Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. Results: Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01–19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19–30.29) and smoking (OR 5.91, 95% CI 1.69–20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16–12.17) and preoperative swallow (OR 3.42, 95% CI 1.23–9.51). Five-year ORN-recurrence-free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43–8.94). Conclusions: Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.",

keywords = "hospital charges, mandibular, osteoradionecrosis, outcomes, survival",

author = "Contrera, {Kevin J.} and Chinn, {Steven B.} and Weber, {Randal S.} and Dianna Roberts and Myers, {Jeffery N.} and Lai, {Stephen Y.} and Lewis, {Carol M.} and Hessel, {Amy C.} and Gillenwater, {Ann M.} and Mulcahy, {Collin F.} and Peirong Yu and Hanasono, {Matthew M.} and Fuller, {Clifton D.} and Chambers, {Mark S.} and Zafereo, {Mark E.}",

note = "Publisher Copyright: {\textcopyright} 2022 Wiley Periodicals LLC.",

year = "2022",

month = jun,

doi = "10.1002/hed.27024",

language = "English (US)",

volume = "44",

pages = "1313--1323",

journal = "Head and Neck",

issn = "1043-3074",

publisher = "Wiley",

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TY - JOUR

T1 - Outcomes after definitive surgery for mandibular osteoradionecrosis

AU - Contrera, Kevin J.

AU - Chinn, Steven B.

AU - Weber, Randal S.

AU - Roberts, Dianna

AU - Myers, Jeffery N.

AU - Lai, Stephen Y.

AU - Lewis, Carol M.

AU - Hessel, Amy C.

AU - Gillenwater, Ann M.

AU - Mulcahy, Collin F.

AU - Yu, Peirong

AU - Hanasono, Matthew M.

AU - Fuller, Clifton D.

AU - Chambers, Mark S.

AU - Zafereo, Mark E.

PY - 2022/6

Y1 - 2022/6

N2 - Objectives: To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). Materials and Methods: Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. Results: Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01–19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19–30.29) and smoking (OR 5.91, 95% CI 1.69–20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16–12.17) and preoperative swallow (OR 3.42, 95% CI 1.23–9.51). Five-year ORN-recurrence-free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43–8.94). Conclusions: Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.

AB - Objectives: To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). Materials and Methods: Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. Results: Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01–19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19–30.29) and smoking (OR 5.91, 95% CI 1.69–20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16–12.17) and preoperative swallow (OR 3.42, 95% CI 1.23–9.51). Five-year ORN-recurrence-free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43–8.94). Conclusions: Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.

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KW - mandibular

KW - osteoradionecrosis

KW - outcomes

KW - survival

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Outcomes after definitive surgery for mandibular osteoradionecrosis

Abstract

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