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Carotid Body Tumor Resection: Just As Safe Without Preoperative Embolization.

Abstract

BACKGROUND

Carotid body tumors (CBT) are rare entities for which surgical resection remains the gold standard. Given their hypervascularity, preoperative embolization is often used, however, controversy exists over whether a benefit is associated. Proponents of embolization argue it minimizes blood loss and complications. Critics argue cost and stroke outweigh benefits. This study aimed to investigate the impact of embolization on outcomes following CBT resection.

METHODS

Patients undergoing CBT resection were identified using the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for 5 states 2006-2013. Patients were divided into two groups: tumor resection alone (CBTR) and embolization prior to resection (CBETR). Descriptive statistics were calculated using arithmetic means with standard deviations for continuous and proportions for categorical variables. Patients were propensity-score matched on the basis of sex, age, race, insurance and comorbidity prior to analysis. Risk-adjusted odds of mortality, stroke, nerve injury, blood loss, and length of stay (LOS) were calculated using mixed-effects regression models with fixed effects for age, race, sex, and comorbidities.

RESULTS

A total of 547 patients were identified. Of these, 472 underwent CBTR and 75 underwent CBETR. Mean age was 54.7 ±16 years. Mean number of days between embolization and resection was 0.65 ±0.72, (range 0-3) days. When compared to CBTR, there were no significant differences in mortality for CBETR (1.35% v. 0 % p=0.316), cranial nerve injury (2.7% v. 0% p=0.48), and blood loss (2.7% v. 6.8% p=0.245). Following risk adjustment, CBETR increased the odds of prolonged LOS (OR: 5.3 CI 2.1-13.3).

CONCLUSION

CBT resection is a relatively rare procedure. The utility of preoperative tumor embolization has been questioned. This study demonstrates no benefit of preoperative tumor embolization.

Authors+Show Affiliations

Loyola University Medical Center, Department of Surgery, Maywood, IL; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago.Loyola University Medical Center, Department of Surgery, Maywood, IL; Loyola University Medical Center, Division of Vascular Surgery and Endovascular Therapy, Maywood, IL.One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago; DePaul University, Department of Predictive Analytics, Chicago, IL.Loyola University Medical Center, Department of Surgery, Maywood, IL; Loyola University Medical Center, Division of Vascular Surgery and Endovascular Therapy, Maywood, IL.Loyola University Medical Center, Department of Surgery, Maywood, IL; Loyola University Medical Center, Division of Vascular Surgery and Endovascular Therapy, Maywood, IL.Loyola University Medical Center, Department of Surgery, Maywood, IL; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago.Loyola University Medical Center, Department of Surgery, Maywood, IL; Loyola University Medical Center, Division of Vascular Surgery and Endovascular Therapy, Maywood, IL. Electronic address: baulivola@lumc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31634604

Citation

Cobb, Adrienne N., et al. "Carotid Body Tumor Resection: Just as Safe Without Preoperative Embolization." Annals of Vascular Surgery, 2019.
Cobb AN, Barkat A, Daungjaiboon W, et al. Carotid Body Tumor Resection: Just As Safe Without Preoperative Embolization. Ann Vasc Surg. 2019.
Cobb, A. N., Barkat, A., Daungjaiboon, W., Halandras, P., Crisostomo, P., Kuo, P. C., & Aulivola, B. (2019). Carotid Body Tumor Resection: Just As Safe Without Preoperative Embolization. Annals of Vascular Surgery, doi:10.1016/j.avsg.2019.09.025.
Cobb AN, et al. Carotid Body Tumor Resection: Just as Safe Without Preoperative Embolization. Ann Vasc Surg. 2019 Oct 18; PubMed PMID: 31634604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carotid Body Tumor Resection: Just As Safe Without Preoperative Embolization. AU - Cobb,Adrienne N, AU - Barkat,Adel, AU - Daungjaiboon,Witawat, AU - Halandras,Pegge, AU - Crisostomo,Paul, AU - Kuo,Paul C, AU - Aulivola,Bernadette, Y1 - 2019/10/18/ PY - 2019/02/12/received PY - 2019/09/18/revised PY - 2019/09/21/accepted PY - 2019/10/22/entrez PY - 2019/10/22/pubmed PY - 2019/10/22/medline KW - CBT KW - carotid body tumor KW - paraganglioma KW - preoperative embolization JF - Annals of vascular surgery JO - Ann Vasc Surg N2 - BACKGROUND: Carotid body tumors (CBT) are rare entities for which surgical resection remains the gold standard. Given their hypervascularity, preoperative embolization is often used, however, controversy exists over whether a benefit is associated. Proponents of embolization argue it minimizes blood loss and complications. Critics argue cost and stroke outweigh benefits. This study aimed to investigate the impact of embolization on outcomes following CBT resection. METHODS: Patients undergoing CBT resection were identified using the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for 5 states 2006-2013. Patients were divided into two groups: tumor resection alone (CBTR) and embolization prior to resection (CBETR). Descriptive statistics were calculated using arithmetic means with standard deviations for continuous and proportions for categorical variables. Patients were propensity-score matched on the basis of sex, age, race, insurance and comorbidity prior to analysis. Risk-adjusted odds of mortality, stroke, nerve injury, blood loss, and length of stay (LOS) were calculated using mixed-effects regression models with fixed effects for age, race, sex, and comorbidities. RESULTS: A total of 547 patients were identified. Of these, 472 underwent CBTR and 75 underwent CBETR. Mean age was 54.7 ±16 years. Mean number of days between embolization and resection was 0.65 ±0.72, (range 0-3) days. When compared to CBTR, there were no significant differences in mortality for CBETR (1.35% v. 0 % p=0.316), cranial nerve injury (2.7% v. 0% p=0.48), and blood loss (2.7% v. 6.8% p=0.245). Following risk adjustment, CBETR increased the odds of prolonged LOS (OR: 5.3 CI 2.1-13.3). CONCLUSION: CBT resection is a relatively rare procedure. The utility of preoperative tumor embolization has been questioned. This study demonstrates no benefit of preoperative tumor embolization. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/31634604/Carotid_Body_Tumor_Resection:_Just_As_Safe_Without_Preoperative_Embolization L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(19)30865-9 DB - PRIME DP - Unbound Medicine ER -