National Analysis of 30‐Day Readmission Following Inpatient Sinus Surgery for Chronic Rhinosinusitis

Abstract

Objectives To characterize the incidence, causes, risk factors, and costs of 30‐day readmission after inpatient functional endoscopic sinus surgery (FESS) for patients with chronic rhinosinusitis. Study Design Retrospective cohort study. Methods The Nationwide Readmissions Database was used to characterize readmission after inpatient sinus surgery for chronic rhinosinusitis from 2015 to 2017. International Classification of Disease codes were used to identify the patient population, which included 5,644 patients. Incidence, causes, costs, and predictors of readmission were analyzed and determined. Results Among 6,386 patients who underwent inpatient FESS, 742 (11.6%) were readmitted within 30 days of discharge. On univariate analysis, patients who were readmitted were more commonly older than 70 years (23.3% vs. 16.2%); had a higher burden of comorbidities including chronic kidney disease (15.0% vs. 7.8%), diabetes (25.6% vs. 20.4%), and hypertension (13.5% vs. 8.5%); had a greater rate of postoperative complications (20.7% vs. 12.2%); and had a longer length of stay (12.4 vs. 6.9 days) compared to patients who were not readmitted. Readmissions cost an additional $27,141 per patient. On multivariable analysis, age greater than 70 years, Medicaid insurance, several comorbidities, prolonged length of stay, postoperative neurologic complications, and lower hospital volume were independent predictors of 30‐day readmission. The most common cause for readmission was infection (36.3%). Conclusion Readmission following inpatient FESS is not uncommon. Identification and management of preoperative comorbidities, optimized patient selection for inpatient surgery, and thorough postoperative discharge care may improve patient outcomes and decrease healthcare expenditures. Level of Evidence 3 Laryngoscope, 131:E1422–E1428, 2021

The Effect of Diabetes Mellitus on Post-Operative Outcomes in Patients Undergoing Endoscopic Sinus Surgery

“…19 However, despite what these studies may suggest a priori, we find no evidence of increased infectious burden for the diabetic patient. Given that reinfection after surgery has been shown to be a significant predictor of readmission risk, 7 these results are doubly reassuring. Further investigation is needed to determine whether the long-term outcomes begin to diverge between the DM and non-DM patient populations.…”

“…Postoperative complications are rare after ESS but an analysis of the National Readmissions Database found that up to 11.6% of patients were readmitted at an average cost of $27 141 per patient. 7 A recent investigation of the relationship between DM and immediate postoperative outcomes (<30 days) found an increased risk for reintubation, pneumonia, and urinary tract infection but no difference in readmission or mortality. 8 Further, DM patients have been found to be at increased risk for gram-negative infection of the paranasal sinuses, 9 although no relationship has been established between DM and increased antibiotic use.…”

Unplanned 30-Day ER Visit Rate and Factors Associated With ER Visits After Ambulatory Sinus Surgery

“…This finding has been previously noted for inpatient FESS and can likely be attributed to reduced resources, less support for managing postoperative complications, and more challenge with returning for follow-up and primary care services. 6,15 Previous studies that examined the trends in readmission rates for the conditions targeted by the HRRP have found a significant decline in readmissions for Medicare and Medicaid patients. 16 Despite these trends, the results of our study suggest that disparity by insurance status persists for ER visits.…”

“…3,4 Subsequent studies that examined the risk factors for hospital readmission after FESS were limited to the inpatient population, predominantly in tertiary academic medical centers, and included heterogeneous patient populations that encompassed CRS and sinonasal tumors. 5,6 Moreover, the demographic and clinical profile of inpatient FESS is likely different from that of ambulatory sinus procedures with a greater burden of comorbidities among the inpatient population. 6 ER visits after outpatient procedures also may not necessarily lead to hospital readmission but can still create tremendous inconvenience and financial hardships for the patients and the facilities.…”

“…5,6 Moreover, the demographic and clinical profile of inpatient FESS is likely different from that of ambulatory sinus procedures with a greater burden of comorbidities among the inpatient population. 6 ER visits after outpatient procedures also may not necessarily lead to hospital readmission but can still create tremendous inconvenience and financial hardships for the patients and the facilities.…”