The ACS-NSQIP study – predictive risk factors and outcomes in primary malignant parotid tumour surgery
Reviewed by Shivanchan Rajmohan

Malignant parotid gland tumours occupy a good proportion of the ENT surgeon’s operative caseload. Large standardised datasets for malignant parotid tumour surgery are limited. This international multi-institutional study is based on the pooled American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, encompassing 3052 patients accumulated over a 14-year period. Specifically, it aimed to evaluate 30-day postoperative outcomes and ascertain predictive risk factors for complications in those undergoing primary malignant parotid tumour surgery. Twenty-five percent underwent superficial parotidectomy with dissection/preservation of facial nerve and 14% had total parotidectomy with dissection / preservation of facial nerve. Mean age of subjects was 63±16 years with majority being Caucasian. A total of 6.8% cases had postoperative complications; being male, older, diabetic, having renal failure, staying as inpatient, weight loss, receiving blood transfusion, previous sepsis, breathlessness, nicotine abuse, metastatic cancer, hypertension requiring treatment and an American Society of Anaesthesiologists (ASA) grade of >4 were recognised as statistically significant risk factors for postoperative complications. Independent risk factors for any complication noted were being an inpatient, diabetic, renal failure, smoker, wound infection and higher ASA grade. Biochemical parameters significantly associated with complications include hypernatremia, high blood urea nitrogen, hypoalbuminemia, leukocytosis and low haematocrit. This ACS-NSQIP study highlights key risk factors for perioperative complications in malignant parotid surgery, emphasising the importance of early identification of vulnerable patient groups who may need tailored postoperative surveillance. Longer-term outcomes including recurrence rates are unknown due to the brevity of the postoperative follow-up period. Being able to generate unique patient risk profiles based on inherent risk factors can be informative preoperatively before embarking on surgery, thereby helping risk stratification.

Risk factors and outcomes after surgery for malignant neoplasm of the parotid gland: An ACS-NSQIP study.
Knoedler L, Knoedler S, Hoch CC, et al.
J PLAST RECONSTR AESTHET SURG
2025;101:264–74.