Effect of Preoperative Counseling on Hospital Length of Stay and Readmissions after Total Laryngectomy

Abstract

Objective Total laryngectomy (TL) is a high-cost procedure with patients at risk for significant postoperative health care use. Face-to-face preoperative counseling provided by speech-language pathologists is a relatively inexpensive intervention that may improve care quality and decrease costs. We evaluated if preoperative counseling for patients undergoing TL was associated with differences in length of stay (LOS), use of the emergency department (ED), or unplanned readmissions within 30 days of discharge. A secondary analysis identified predictors of these 3 outcomes. Study Design Case series with chart review. Setting Academic medical center in the United States. Subjects and Methods Patients were included if they underwent TL from 2011 to 2015. Patient demographics and comorbidities, surgical characteristics, and perioperative care data were retrieved and analyzed for 116 patients. Univariate and multivariate models were constructed for 3 outcomes. Results LOS was significantly lower for patients receiving counseling (-3.0 days, P = .02). No differences were observed in rates of 30-day ED visits or unplanned readmissions. Care provided by high-volume surgeons was associated with decreased LOS ( P = .005), while having postoperative complications increased LOS ( P < .001). High rates of ED visits (12.1%) and readmissions (20.6%) were observed. Discharge to inpatient rehabilitation and the patient's home distance from the institution were predictors of ED visits. TL as salvage therapy and occurrence of postoperative complications were risk factors for readmission. Conclusion Preoperative counseling was associated with marked reduction in LOS following TL without increased readmissions, which suggests that it may promote safe, earlier patient readiness for discharge.

Risk factors for thirty‐day readmission following flap reconstruction of oncologic defects of the head and neck

“…The median time between discharge and readmission in the present series was 8 days, and this is similar to other studies . Many early readmissions were for wound complications, and 44% of readmissions during the first week postdischarge were for SSIs.…”

“…Nearly half of readmissions were due to wound infections or pharyngocutaneous fistula. Shenson et al reported a readmission rate postdischarge of 20.6% for 116 patients undergoing total laryngectomy or laryngopharyngectomy at a single center . However, only 24% underwent pedicled flap reconstruction, and 8% underwent free flap reconstruction.…”

Thirty‐day readmission in patients undergoing head and neck microvascular reconstruction

“…This is similar to the findings of Offodile et al, who also found that nonoral cavity aerodigestive tract subsites were associated with an increased risk of readmission. Other series analyzing unplanned readmissions in patients with pharyngeal or laryngeal cancer have also found high rates of unplanned readmission, ranging from 13.9%‐29.6% . These patients may be at higher risk of readmission relative to patients receiving free flaps for oral cavity reconstruction because of a higher rate of prior (chemo)radiation, predisposing them to delayed wound healing complications that manifest after discharge, resulting in readmission.…”

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“…Patients with laryngeal and hypopharyngeal cancers who undergo laryngectomy are high resource users in the immediate peritreatment period with a median length of stay of 15 days (interquartile range 12‐25.5), an average of 54.2 days of home care after discharge, and a 29.9% chance of requiring readmission. These data are in keeping with other reports in this population . These metrics provide a baseline that can be used to target quality improvement initiatives, particularly as it relates to length of stay and 30‐day readmission, and requires further investigation.…”