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 language | English (US) |
|---|---|
| Journal | Otolaryngology - Head and Neck Surgery (United States) |
| DOIs | |
| State | Accepted/In press - May 1 2018 |
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Keywords
- head and neck cancer
- PS/QI
- readmissions
- risk factors
ASJC Scopus subject areas
- Surgery
- Otorhinolaryngology
Cite this
Head and Neck Cancer Patients : Rates, Reasons, and Risk Factors for 30-Day Unplanned Readmission. / Ghiam, Michael K.; Langerman, Alexander; Sargi, Zoukaa B; Rohde, Sarah.
In: Otolaryngology - Head and Neck Surgery (United States), 01.05.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Head and Neck Cancer Patients
T2 - Rates, Reasons, and Risk Factors for 30-Day Unplanned Readmission
AU - Ghiam, Michael K.
AU - Langerman, Alexander
AU - Sargi, Zoukaa B
AU - Rohde, Sarah
PY - 2018/5/1
Y1 - 2018/5/1
N2 - 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.
AB - 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.
KW - head and neck cancer
KW - PS/QI
KW - readmissions
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=85047396148&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047396148&partnerID=8YFLogxK
U2 - 10.1177/0194599818776633
DO - 10.1177/0194599818776633
M3 - Article
C2 - 29787349
AN - SCOPUS:85047396148
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
SN - 0194-5998
ER -