Head and Neck Cancer Patients: Rates, Reasons, and Risk Factors for 30-Day Unplanned Readmission

Michael K. Ghiam, Alexander Langerman, Zoukaa Sargi, Sarah Rohde

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Objective: To analyze rates, risk factors, and complications for 30-day readmission among head and neck cancer (HNC) patients. Methods: Retrospective review of administrative records from Vizient (Irving, Texas) Clinical Data Base/Resource Manager on HNC patients who underwent a head and neck surgical procedure from January 2013 through September 2015 at 176 academic and community medical centers. Results: Of the 18,121 patients included in the study, 2502 patients were readmitted within 30 days (13.8%). Mean time to readmission was 11 ± 8.2 days. Cancer of the hypopharynx, oropharynx, pharynx, and larynx all had higher odds of readmission compared to oral cavity (odds ratio [OR], 1.8, 1.7, 1.6, and 1.5; 95% confidence interval [CI], 1.4-2.2, 1.4-1.9, 1.2-2.3, and 1.3-1.7, respectively). Consistent with this, flap procedures and laryngectomy had the highest odds of readmission (OR, 1.4 and 1.3; 95% CI, 1.3-1.6 and 1.0-1.5 vs glossectomy, respectively). The most common surgical causes for readmission were postoperative infection (17.6%) and surgical wound dehiscence (16.8%), which most commonly presented on postdischarge days 4 to 5. Acute cardiac events occurred in up to 15.4% of patients depending on complexity of surgery. Dysphagia and electrolyte disturbances were common (15.8% and 15.4%, respectively); patients with these complications typically presented earlier, between days 3 and 4. Discussion: Patients with HNC are at high risk of readmission. The cancer subsite and procedure significantly influenced the risk, rate, and reason for readmission. Implications for Practice: Findings from this study can help quality improvement and patient safety administrators develop interventions that uniquely target HNC populations.

Original languageEnglish (US)
Pages (from-to)149-157
Number of pages9
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume159
Issue number1
DOIs
StatePublished - Jul 1 2018

Keywords

  • PS/QI
  • head and neck cancer
  • readmissions
  • risk factors

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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