Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer

Badr, Hoda; Sobrero, Maximiliano; Chen, Joshua; Kotz, Tamar; Genden, Eric M.; Sikora, Andrew G.; Miles, Brett A.

doi:10.1016/j.oraloncology.2019.02.004

Cited by 10 publications

(5 citation statements)

References 58 publications

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“…Our data demonstrate several predictors of readmission that were consistent with single institutions and national studies. In brief, the following variables were associated with readmission: male sex, 7,11,12,25,26 medical comorbidities, 12,23,27 primary tumor subsite, 12,[27][28][29] nonelective surgery, 2,30 Medicaid and Medicare insurance, 2,31,32 discharge to a facility, 7,27,29,32 and metropolitan teaching hospital status. 12,33 Unique to previously published literature, we also assessed the effect of prior treatment on 30-day readmission following head and neck cancer surgeries.…”

Section: Discussionmentioning

confidence: 99%

Hypothyroidism as an Independent Predictor of 30‐day Readmission in Head and Neck Cancer Patients

et al. 2023

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ObjectivesTo define the role of hypothyroidism and other risk factors for unplanned readmissions after surgery for head and neck cancer.Study DesignRetrospective cohort study.MethodsThe Nationwide Readmission Database (NRD) was used to identify patients who underwent surgery for mucosal head and neck cancer (oral cavity, oropharynx, larynx, and hypopharynx) between 2010 and 2017. Univariate and multivariate logistic regression were performed to determine patient, tumor, and hospital related risk factors for 30‐day readmission. Readmitted patients were stratified by preoperative diagnosis of hypothyroidism to compare readmission characteristics.ResultsFor the 131,013 patients who met inclusion criteria, the readmission rate was 15.9%. Overall, 11.91% of patients had a preoperative diagnosis of hypothyroidism. After controlling for other variables, patients with a preoperative diagnosis of hypothyroidism had 12.2% higher odds of readmission compared to those without hypothyroidism (OR: 1.12, 1.03–1.22, p = 0.008). Patients with hypothyroidism had different reasons for readmission, including higher rates of wound dehiscence, fistula, infection, and electrolyte imbalance. Among readmitted patients, the length of stay for index admission (mean 10.5 days vs. 9.2 days, p < 0.001), readmission (mean 7.0 vs. 6.6 days, p = 0.05), and total hospital charge were higher for hypothyroid patients ($137,742 vs. $119,831, p < 0.001).ConclusionHypothyroidism is an independent risk factor for 30‐day readmission following head and neck cancer resection. Furthermore, hypothyroid patients are more likely to be readmitted for wound complications, infection, and electrolyte imbalance. Targeted interventions should be considered for hypothyroid patients to decrease readmission rates and associated patient morbidity, potentially leading to earlier initiation of adjuvant treatment.Level of Evidence3 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Hypothyroidism as an Independent Predictor of 30‐day Readmission in Head and Neck Cancer Patients

et al. 2023

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“…B. einer erhöhten Pneumonierate [29] oder aber der prolongierten Nutzung der Sondenernährung [33]. Zusätzlich findet sich gerade das männliche Geschlecht als Prädiktor für eine ungeplante Rehospitalisierung innerhalb eines Monats nach operativer Kopf-Hals-Tumorbehandlung [34]. Dabei steht das männliche Geschlecht in Zusammenhang mit anderen bekannten Einflussfaktoren, die nachgewiesenermaßen die Dysphagieentwicklung mitbeeinflussen [35,36] und bei Männern häufiger zu verzeichnen sind.…”

Section: Originalarbeitunclassified

Postoperative Dysphagieprävalenz bei Kopf-Hals-Tumorpatienten im akutstationären Setting

Goeze

Zaretsky

Lehner

et al. 2021

Laryngorhinootologie

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Zusammenfassung Hintergrund Dysphagie bildet eine häufige postoperative Funktionsbeeinträchtigung bei Kopf-Hals-Tumorpatienten. Diese kann in Aspiration bzw. Penetration sowie Oralisierungseinschränkung resultieren und ist dadurch häufig versorgungsrelevant. In dieser Studie wurden die Prävalenz einer postoperativen Dysphagie und der Zusammenhang zwischen Ausprägungsgrad und Tumorstadium, Tumorlokalisation, Patientenalter und -geschlecht im akutstationären Setting untersucht. Material und Methoden Prospektiv wurden 201 erwachsene Kopf-Hals-Tumorpatienten (Altersdurchschnitt 63 Jahre) in 2 Universitätskliniken hinsichtlich Penetration/Aspiration, Oralisierungseinschränkung und Versorgungsrelevanz direkt nach der operativen Tumorbehandlung via FEES untersucht. In uni- und multivariaten Berechnungen wurde zudem der Einfluss der o. g. Patientenmerkmale auf diese 3 Parameter analysiert. Ergebnisse Eine versorgungsrelevante Schluckstörung bestand bei 66,7 % (134/201) der Patienten. 57,2 % der Patienten benötigten eine Nasogastral- oder PEG-Sonde bei therapierelevanter Oralisierungseinschränkung, weitere 45,3 % aspirierten, 38,5 % von diesen still. Als signifikante Einflussfaktoren erwiesen sich ein höheres Tumorstadium und Patientenalter sowie männliches Geschlecht, die Tumorlokalisation dagegen nur marginal. Schlussfolgerungen Die Studienergebnisse demonstrieren die klinische Bedeutung und die Notwendigkeit der konsequenten und systematischen Versorgung postoperativer Schluckstörungen bei Kopf-Hals-Tumorpatienten im akutstationären Aufenthalt zur Komplettierung moderner onkologischer Therapie.

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“…With up to 75% of this patient population, their prevalence is remarkably high [ 3 ] and varies depending on the tumor site and size as well as resection extent [ 4 , 5 ]. Oropharyngeal dysphagia can cause substantial life-threatening complications such as aspiration pneumonia and malnutrition that are both associated with an increased morbidity [ 4 , 6 – 8 ], length of hospital stay [ 9 , 10 ], and tube dependency [ 11 , 12 ]. Thus, early identification of dysphagia and its timely management are vital for the reduction of these critical postsurgical sequels both for patient’s health and healthcare system [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

FraMaDySc: dysphagia screening for patients after surgery for head and neck cancer

Hey

Goeze

Sader

et al. 2023

Eur Arch Otorhinolaryngol

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Purpose Oropharyngeal dysphagia is one of the most common postoperative consequences in head and neck cancer patients. Above all, these patients often suffer from aspiration and limitations of oral intake. However, no reliable dysphagia screening is available for this target group. This study aimed to develop and validate a screening, FraMaDySc, based on a water swallow test (WST) for the identification of postsurgical patients with a risk of aspiration, limitations of oral intake, and, as their derivate, a relevant oropharyngeal dysphagia in general (OD) that constituted the main reference standard. Methods A total of 184 postsurgical head and neck cancer patients were tested with a WST. The patients were, on average, 62 years old and predominantly male (71%). After WST, they underwent Fiberoptic Endoscopic Evaluation of Swallowing (FEES®). FEES® results were dichotomized by Penetration aspiration scale and Functional oral intake scale. Patients with a “fail” result on one of these two scales were classified as having OD. Quality criteria of WST were quantified by means of cross-tabulation with FEES® results. Results OD was found in 65% of patients, aspiration in 44%, limitations of oral intake in 56%. WST delivered a “fail” result in 65% of patients. WST showed sensitivity 91% and specificity 88% for OD. Quality criteria for aspiration (sensitivity 64%, specificity 93%) and limitations of oral intake (sensitivity 80%, specificity 87%) were lower. Conclusion FraMaDySc is a standardized, quick, and valid WST and therefore an excellent screening tool for the identification of OD in postoperative head and neck cancer patients.

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Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer

Cited by 10 publications

References 58 publications

Hypothyroidism as an Independent Predictor of 30‐day Readmission in Head and Neck Cancer Patients

Hypothyroidism as an Independent Predictor of 30‐day Readmission in Head and Neck Cancer Patients

Postoperative Dysphagieprävalenz bei Kopf-Hals-Tumorpatienten im akutstationären Setting

FraMaDySc: dysphagia screening for patients after surgery for head and neck cancer

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