The Tumor Risk Score (TRS) – next level risk prediction in head and neck tumor surgery

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose</jats:title> <jats:p>Head and neck cancer surgery often requires postoperative monitoring in an intensive care unit (ICU) or intermediate care unit (IMC). With a variety of different risk scores, it is incumbent upon the investigator to plan a risk-adapted allocation of resources. Tumor surgery in the head and neck region itself offers a wide range of procedures in terms of resection extent and reconstruction methods, which can be stratified only vaguely by a cross-disciplinary score. Facing a variety of different risk scores we aimed to develop a new Tumor Risk Score (TRS) enabling anterograde preoperative risk evaluation, resource allocation and optimization of cost and outcome measurements in tumor surgery of the head and neck.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>A collective of 547 patients (2010–2021) with intraoral tumors was studied to develop the TRS by grading the preoperative tumor size and location as well as the invasiveness of the planned surgery by means of statistical modeling. Two postoperative complications were defined: (1) prolonged postoperative stay in IMC/ICU and (2) prolonged total length of stay (LOS). Each parameter was analyzed using TRS and all preoperative patient parameters (age, sex, preoperative hemoglobin, body-mass-index, preexisting medical conditions) using predictive modeling design. Established risk scores (Charlson Comorbidity Index (CCI), American Society of Anesthesiologists risk classification <jats:italic>(</jats:italic>ASA), Functional Comorbidity Index (FCI)) and Patient Clinical Complexity Level (PCCL) were used as benchmarks for model performance of the TRS.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The TRS is significantly correlated with surgery duration (<jats:italic>p</jats:italic> < 0.001) and LOS (<jats:italic>p</jats:italic> = 0.001). With every increase in TRS, LOS rises by 9.3% (95%CI 4.7–13.9; <jats:italic>p</jats:italic> < 0.001) or 1.9 days (95%CI 1.0-2.8; <jats:italic>p</jats:italic> < 0.001), respectively. For each increase in TRS, the LOS in IMC/ICU wards increases by 0.33 days (95%CI 0.12–0.54; <jats:italic>p</jats:italic> = 0.002), and the probability of an overall prolonged IMC/ICU stay increased by 32.3% per TRS class (<jats:italic>p</jats:italic> < 0.001). Exceeding the planned IMC/ICU LOS, overall LOS increased by 7.7 days (95%CI 5.35–10.08; <jats:italic>p</jats:italic> < 0.001) and increases the likelihood of also exceeding the upper limit LOS by 70.1% (95%CI 1.02–2.85; <jats:italic>p</jats:italic> = 0.041). In terms of predictive power of a prolonged IMC/ICU stay, the TRS performs better than previously established risk scores such as ASA or CCI (<jats:italic>p</jats:italic> = 0.031).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The lack of a standardized needs assessment can lead to both under- and overutilization of the IMC/ICU and therefore increased costs and losses in total revenue. Our index helps to stratify the risk of a prolonged IMC/ICU stay preoperatively and to adjust resource allocation in major head and neck tumor surgery.</jats:p> </jats:sec&gt

Head circumference - a useful single parameter for skull volume development in cranial growth analysis?

Abstract Background The measurement of maximal head circumference is a standard procedure in the examination of childrens’ cranial growth and brain development. The objective of the study was to evaluate the validity of maximal head circumference to cranial volume in the first year of life using a new method which includes ear-to-ear over the head distance and maximal cranial length measurement. Methods 3D surface scans for cranial volume assessment were conducted in this method comparison study of 44 healthy Caucasian children (29 male, 15 female) at the ages of 4 and 12 months. Results Cranial volume increased from measurements made at 4 months to 12 months of age by an average of 1174 ± 106 to 1579 ± 79 ml. Maximal cranial circumference increased from 43.4 ± 9 cm to 46.9 ± 7 cm and the ear-to ear measurement increased from 26.3 ± 21 cm to 31.6 ± 18 cm at the same time points. There was a monotone association between maximal head circumference (HC) and increase in volume, yet a backwards inference from maximal circumference to the volume had a predictive value of only 78% (adjusted R2). Including the additional measurement of distance from ear to ear strengthened the ability of the model to predict the true value attained to 90%. The addition of the parameter skull length appeared to be negligible. Conclusion The results demonstrate that for a distinct improvement in the evaluation of a physiological cranial volume development, the additional measurement of the ear-to ear distance using a measuring tape is expedient, and, especially for cases with pathological skull changes, such as craniosynostosis, ought to be conducted