Predictors and costs of readmissions at an academic head and neck surgery service

Dziegielewski, Peter T.; Boyce, Brian; Manning, Amy; Agrawal, Amit; Old, Matthew; Özer, Enver; Teknos, Theodoros N.

doi:10.1002/hed.24030

Cited by 61 publications

(140 citation statements)

References 35 publications

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“…Hospital re-admission rate is now used as a health care quality indicator though multiple studies have shown that high re-admission rate is not associated with inferior care [9–15]. The Patient Protection and Affordable Care Act of 2010 identified 30-day unplanned hospital re-admissions as a major contributor to Medicare overspending and this has driven the push to penalize facilities with high re-admission rates [14]. This push for quality-based reimbursement was proposed by the Center for Medicare and Medicaid Services and has directed financial penalties for institutions whose quality outcomes, such as re-admission rates and complications, are below acceptable standards [15–17].…”

Section: Discussionmentioning

confidence: 99%

“…The overall rate of 30 day hospital re-admissions in head and neck surgery patients is roughly 10% [14,15]. Our study is not the first study to evaluate risk factors for re-admission in head and neck cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…Our study is not the first study to evaluate risk factors for re-admission in head and neck cancer patients. In multiple studies, wound complications such as fistula or infection are among the most common reasons for readmission, with an estimate of 51% of re-admissions being related to complications [14,15,18]. Advanced tumor stage (T3-T4) as well as longer length of stay have also been found to be predictors re-admission [13,18].…”

Section: Discussionmentioning

confidence: 99%

“…Advanced tumor stage (T3-T4) as well as longer length of stay have also been found to be predictors re-admission [13,18]. Interestingly, the presence of a G-tube at discharge was found to have a 3-fold increase in the rate of re-admission, and was also found to predict re-admission for pneumonia [14]. Another study found that pre-operative G-tubes were predictors of re-admission after resection [15].…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged length of stay has been found to be a very significant predictor of hospital re-admission across surgical subspecialties [15,19]. Only one study could be found that quantified the degree of prolonged care, showing that greater than five days demonstrated a 3-fold increased risk of re-admission [14]. Weight loss greater than 10% in the 6 months prior to surgery and high ASA class were found to be significant predictors of prolonged LOS [20].…”

Section: Discussionmentioning

confidence: 99%

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The association between gastrostomy tube placement, poor post-operative outcomes, and hospital re-admissions in head and neck cancer patients

Mays¹,

Worley²,

Ackall³

et al. 2015

Surgical Oncology

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Objectives Investigate the relationship of G-tube placement timing on post-operative outcomes. Participants 908 patients underwent resection of head and neck upper aerodigestive tract tumors between 2007 and 2013. Patient charts were retrospectively screened for patient demographics, pre-operative nutrition variables, co-morbid conditions, Tumor-Node-Metastasis staging, surgical treatment type, and timing of G-tube placement. Exclusionary criteria included death within the first three months of the resection and resections performed solely for nodal disease. Main Outcomes Post-surgical outcomes, including wound and medical complications, hospital re-admissions, length of inpatient hospital stay (LOS), intensive care unit (ICU) time. Results 793 surgeries were included: 8% of patients had G-tubes pre-operatively and 25% had G-tubes placed post-operatively. Patients with G-tubes (pre-operative or post-operative) were more likely to have complications and prolonged hospital care as compared to those without G-tubes (p < 0.001). Patients with pre-operative G-tubes had shortened length of stay (p = 0.007), less weight loss (p = 0.03), and fewer wound care needs (p < 0.0001), when compared to those that received G-tubes post-operatively. Those with G-tubes placed post-operatively had worse outcomes in all categories, except pre-operative BMI. Conclusions Though having enteral access in the form of a G-tube at any point suggests a more high risk patient, having a G-tube placed in the pre-operative period may protect against poor post-operative outcomes. Post-operative outcomes can be predicted based on patient characteristics available to the physician in the pre-operative period.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The association between gastrostomy tube placement, poor post-operative outcomes, and hospital re-admissions in head and neck cancer patients

Mays¹,

Worley²,

Ackall³

et al. 2015

Surgical Oncology

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Risk Factors, Causes, and Costs of Hospital Readmission After Head and Neck Cancer Surgery Reconstruction

Goel

Raghavan

John

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Thirty-day hospital readmissions have substantial direct costs and are increasingly used as a measure of quality care. However, data regarding the risk factors and reasons for readmissions in head and neck cancer surgery reconstruction are lacking. OBJECTIVE To describe the rate, risk factors, and causes of 30-day readmission in patients with head and neck cancer following free or pedicled flap reconstruction. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study analyzed medical records from the Nationwide Readmissions Database of 9487 patients undergoing pedicled or free flap reconstruction of head and neck oncologic defects between January 1, 2010, and December 31, 2014. Data analysis was performed in October 2017. EXPOSURES Pedicled or free flap reconstruction of an oncologic head and neck defect. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day all-cause readmissions. Secondary outcomes included risk factors, causes, and costs of readmission. Multivariate regression analyses were conducted to determine factors independently associated with 30-day readmissions. RESULTS Among 9487 patients included in the study (6798 male; 71.7%), the median age was 63 years (interquartile range, 55-71 years), and the 30-day readmission rate was 19.4% (n = 1839), with a mean cost per readmission of $15 916 (standard error of the mean, $785). The most common indication for readmission was wound complication (26.5%, n = 487). On multivariate regression, significant risk factors for 30-day readmission were median household income in the lowest quartile (vs highest quartile: odds ratio [

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Risk Factors Associated With Unplanned Readmission in Patients Undergoing Parotid Cancer Surgery

Zhan

Graboyes

Nguyen

et al. 2016

JAMA Otolaryngol Head Neck Surg

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Predictors and costs of readmissions at an academic head and neck surgery service

Abstract: The 30dURs in patients who undergo head and neck surgery can be low, but costly. Identifying patients at risk for 30dUR will help develop preventative strategies. © 2015 Wiley Periodicals, Inc. Head Neck 38: E502-E510, 2016.

Cited by 61 publications

References 35 publications

The association between gastrostomy tube placement, poor post-operative outcomes, and hospital re-admissions in head and neck cancer patients

The association between gastrostomy tube placement, poor post-operative outcomes, and hospital re-admissions in head and neck cancer patients

Risk Factors, Causes, and Costs of Hospital Readmission After Head and Neck Cancer Surgery Reconstruction

Risk Factors Associated With Unplanned Readmission in Patients Undergoing Parotid Cancer Surgery

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