Contents lists available at ScienceDirect Am J Otolaryngol journal homepage: www.elsevier.com/locate/amjoto Does neck dissection affect post-operative outcomes in parotidectomy? A national study Philip R. Brauer a,b , Chandana A. Reddy c , Jamie A. Ku b , Brandon L. Prendes b , Eric D. Lamarre b, ⁎ a Case Western Reserve University School of Medicine, Cleveland, OH, USA b Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA c Taussig Cancer Institute, The Cleveland Clinic, Cleveland, OH, USA ARTICLE INFO Keywords: Parotidectomy Neck dissection Otolaryngology Metastasis Parotid cancer ABSTRACT Objective: To characterize post-operative complications in parotidectomy with neck dissection. Methods: Patients age ≥ 18 receiving a parotidectomy or parotidectomy with neck dissection between 2005 and 2017 were eligible for inclusion. Patients with unknown demographic variables were excluded. Univariate and multivariable logistic regression analyses were performed. Results: A total of 13,609 parotidectomy patients were analyzed, 11,243 (82.6%) without neck dissection and 2366 (17.4%) with neck dissection. Both length of surgery (mean minutes ± standard deviation [SD] = 335.9 ± 189.2 vs. 152.9 ± 99.0, p < 0.001) and length of hospital stay (mean days ± SD = 3.90 ± 4.76 vs. 1.04 ± 2.14, p < 0.001) were greater with dissection. 13.9% of par- otidectomies with neck dissection and 3.5% without dissection (p < 0.001) had at least one complication, which remained significant after multivariable adjustment (Odds Ratio[OR] = 1.565 (95%CI = 1.279–1.914), p < 0.001). The increase in post-operative complications was predominately driven by an increased transfusion rate (7.4% vs. 0.5%, p < 0.001). Multivariable analysis also demonstrated no significant difference in rates of returning to the operating room (OR = 1.122 (95%CI 0.843–1.493), p > 0.05) or rates of readmission (OR = 1.007 (95%CI 0.740–1.369), p > 0.05). Parotidectomy with neck dissection was more likely to be inpatient (OR = 4.411 (95%CI 3.887–5.004), p < 0.001) and to be ASA class 3 (OR = 1.367 (95%CI 1.194–1.564), p < 0.001). Conclusions: Nationwide data demonstrates that parotidectomy with neck dissection is associated with increased rates of post-operative complications; however, neck dissection did not significantly impact readmission or re- operation rates. These findings indicate that neck dissection is a relatively safe addition to parotidectomy and provide novel evidence in the management of parotid malignancies. 1. Introduction Tumors of the parotid gland are a relatively rare presentation with an incidence of approximately 1 to 4 cases per 100,000 people each year [1,2]. There are a number of controversies in proper management due in part to the histologic variety of parotid gland tumors and the lack of data to support different modalities [3,4]. Treatment guidelines provided by the National Comprehensive Care Network (NCCN) focus primarily on surgical excision for parotid gland malignancies; however, in an N0 neck there is no consensus on the criteria for when to perform a neck dissection [5,6]. A number of studies on clinically N0 parotid tumors have supported the role of neck dissection in improved locor- egional control for select patients at increased risk of metastases [7,8]. In contrast, literature also argues that adjuvant radiation offers improved locoregional control for N0 patients; yet, other studies have evaluated the therapeutic benefit of observation depending on the grade and stage [8–11]. Management of parotidectomy patients pre- senting with a clinically N0 neck largely remains controversial. For head and neck surgeons, neck dissection is critical to both sta- ging and treatment in patients at risk for cervical metastases, which is one of the most established poor prognostic factors [12,13]. On the other hand, neck dissection is known to carry additional risk of perio- perative and postoperative complications, including surgical site in- fection and blood transfusion [14–16]. The elective nature of N0 neck dissections in parotidectomy means careful consideration of complica- tions relative to benefits is the basis for determining the optimal treatment. To the best of our knowledge, there have been no national studies https://doi.org/10.1016/j.amjoto.2020.102593 Received 21 May 2020 ⁎ Corresponding author at: Head and Neck Institute, Cleveland Clinic, 9500 Euclid Ave., A71, Cleveland, OH 44195, USA. E-mail address: lamarre@ccf.org (E.D. Lamarre). Am J Otolaryngol 41 (2020) 102593 0196-0709/ © 2020 Published by Elsevier Inc. T