Risk Factors for Unplanned Hospital Readmission in Otolaryngology Patients

Abstract

further organize them by gender, academic rank, fellowship training status, and institutional location. The Scopus database was used to assess various bibliometrics of these otolaryngologists, including the h-index, number of publications, and publication range (in years).Results: Analysis included 1,127 otolaryngologists, 916 men (81.3%) and 211 women (18.7%). Female faculty comprised 15.4% in the Midwest, 18.8% in the Northeast, 21.3% in the South, and 19.0% in the West (p=0.44). Overall, men obtained significantly higher senior academic ranks (Associate Professor or Professor) compared to women (59.8% vs. 40.2%, p<0.0001). Regional gender differences among senior faculty were found in the South (59.8% men vs. 37.3% women, p=0.0003) and in the Northeast (56.4% men vs. 24.1% women, p<0.0001) with concomitant gender differences in scholarly impact, as measured by the h-index (South, p=0.0003; Northeast, p=0.0001). Among geographic subdivisions, female representation at senior ranks was lowest in the Mid-Atlantic (21.9%), New England (17.1%), and West South Central (33.3%), while highest in the Pacific (60.0%) and Mountain (71.4%) regions. No regional gender differences were found in fellowship training patterns (p-values>0.05).Conclusions: Gender disparities in academic rank and scholarly productivity exist regionally, most notably in the Northeast where women in otolaryngology are most underrepresented relative to men at senior academic ranks and in scholarly productivity.

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

“…Further, outcomes measures are now being evaluated by health care insurers and our government to determine reimbursement. 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].…”

“…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]. Proactive measures on the part of the head and neck surgical team to reduce the incidence of these poor outcomes is now all the more important.…”

“…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.…”

“…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].…”

“…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]. Despite these findings that suggest a negative effect of G-tubes on outcomes, our findings suggest a potential protective quality of pre-operative G-tubes.…”