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

Osborn, Heather A.; Rathi, Vinay K.; Tjoa, Tjoson; Goyal, Neerav; Yarlagadda, Bharat B.; Rich, Debbie L.; Emerick, Kevin S.; Lin, Derrick T.; Deschler, Daniel G.; Durand, Marlene L.

doi:10.1002/lary.26726

Cited by 24 publications

(29 citation statements)

References 17 publications

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“…Although a recent review demonstrated history of radiation had a relative risk of 1.5 for PCF development, other studies have indicated that the risk may be related to the timing of radiation relative to surgery, dose received, and field of radiation . One study evaluating predictors of readmission after flap reconstruction also noted that prior radiation therapy did not increase the risk of readmission in their cohort . Although our study indicated that prior radiation alone is not a predictor of readmission, this may be due to an inability to capture and differentiate the specific details of radiotherapy treatment regimens .…”

Section: Discussioncontrasting

confidence: 66%

“…16,26,27 One study evaluating predictors of readmission after flap reconstruction also noted that prior radiation therapy did not increase the risk of readmission in their cohort. 28 Although our study indicated that prior radiation alone is not a predictor of readmission, this may be due to an inability to capture and differentiate the specific details of radiotherapy treatment regimens. 26 Unfortunately, given the relatively low incidence of PCF in our study, we were not specifically powered to analyze the factors that contribute to PCF formation.…”

Section: Wound Infection and Pharyngocutaneous Fistulamentioning

confidence: 68%

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The national landscape of unplanned 30‐day readmissions after total laryngectomy

Ferrandino

Garneau²,

Roof³

et al. 2017

The Laryngoscope

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Section: Discussioncontrasting

confidence: 66%

Section: Wound Infection and Pharyngocutaneous Fistulamentioning

confidence: 68%

The national landscape of unplanned 30‐day readmissions after total laryngectomy

Ferrandino

Garneau²,

Roof³

et al. 2017

The Laryngoscope

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“…With average length of stays in these studies exceeding 9 days, this limitation is likely to underestimate the rate of 30-day readmissions. Two single-institution studies of head and neck cancer reconstruction, at Brigham and Women's Hospital 12 and Massachusetts Eye and Ear Infirmary, 13 have reported rates of 11.6% and 19.8%, respectively. Single-center readmission rates must be interpreted with caution given the inability to capture readmissions to outside institutions, which have represented as many as one-third of readmissions in prior studies.…”

Section: Rate Of Readmissionmentioning

confidence: 99%

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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“…13 SSIs increase morbidity, but also contribute to increased hospital resource utilization, both costs per admission, readmission rates, and length of stay (LOS). [14][15][16][17][18][19][20][21] To improve quality in medical care, it is important to identify sources of significant perioperative morbidity and their consequential burden on healthcare systems; this information is critical for establishing and monitoring quality improvement strategies. However, despite the emphasis that quality improvement strategies place on reducing LOS, objective data evaluating predictors of prolonged admission in HNS are largely limited to single-center studies or specific head and neck subpopulations.…”

Section: Introductionmentioning

confidence: 99%

Surgical Site Infection Affects Length of Stay After Complex Head and Neck Procedures

et al. 2020

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Objectives/Hypothesis: Quality improvement (QI) initiatives emphasize a need for reduction in hospital length of stay (LOS). We sought to determine the impact of surgical site infections (SSIs) on LOS after complex head and neck surgery (HNS). Study Design: Retrospective cohort analysis. Methods: An analysis of the American College of Surgeons National Surgical Quality Improvement Program was undertaken. All adult patients undergoing complex HNS from 2005 to 2016 were included in the analysis. Our main outcomes were SSI incidence and increase in hospital LOS attributable to SSI. Results: Of 4,014 patients identified, 16.5% developed SSI. History of smoking, diabetes, preoperative wound infection, contaminated or dirty wound classes, and prolonged operative time were found to significantly predict postoperative SSI. Adjusting for significant pre-and postoperative factors, SSI was associated with significantly increased LOS (hazard ratio = 0.486, 95% confidence interval: 0.419-0.522). Conclusions: SSI following complex HNS is associated with significantly increased hospital LOS. This result supports the need for institutional QI strategies that target SSIs after head and neck procedures in an effort to provide the highest quality care at the lowest possible cost. Our analysis identifies risk factors that can allow identification of patients at high risk of SSI and prolonged hospitalization.

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

Abstract: 4. Laryngoscope, 128:343-349, 2018.

Cited by 24 publications

References 17 publications

The national landscape of unplanned 30‐day readmissions after total laryngectomy

The national landscape of unplanned 30‐day readmissions after total laryngectomy

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

Surgical Site Infection Affects Length of Stay After Complex Head and Neck Procedures

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