Head and Neck Cancer Patients: Rates, Reasons, and Risk Factors for 30‐Day Unplanned Readmission

Abstract

Objective To analyze rates, risk factors, and complications for 30-day readmission among head and neck cancer (HNC) patients. Methods Retrospective review of administrative records from Vizient (Irving, Texas) Clinical Data Base/Resource Manager on HNC patients who underwent a head and neck surgical procedure from January 2013 through September 2015 at 176 academic and community medical centers. Results Of the 18,121 patients included in the study, 2502 patients were readmitted within 30 days (13.8%). Mean time to readmission was 11 ± 8.2 days. Cancer of the hypopharynx, oropharynx, pharynx, and larynx all had higher odds of readmission compared to oral cavity (odds ratio [OR], 1.8, 1.7, 1.6, and 1.5; 95% confidence interval [CI], 1.4-2.2, 1.4-1.9, 1.2-2.3, and 1.3-1.7, respectively). Consistent with this, flap procedures and laryngectomy had the highest odds of readmission (OR, 1.4 and 1.3; 95% CI, 1.3-1.6 and 1.0-1.5 vs glossectomy, respectively). The most common surgical causes for readmission were postoperative infection (17.6%) and surgical wound dehiscence (16.8%), which most commonly presented on postdischarge days 4 to 5. Acute cardiac events occurred in up to 15.4% of patients depending on complexity of surgery. Dysphagia and electrolyte disturbances were common (15.8% and 15.4%, respectively); patients with these complications typically presented earlier, between days 3 and 4. Discussion Patients with HNC are at high risk of readmission. The cancer subsite and procedure significantly influenced the risk, rate, and reason for readmission. Implications for Practice Findings from this study can help quality improvement and patient safety administrators develop interventions that uniquely target HNC populations.

30-day unplanned readmission rate in otolaryngology patients: A population-based study in Thuringia, Germany

“…The detected readmission predictors 1) head and neck cancer, 2) higher comorbidity, and 3) non-surgical cases have also been shown to be relevant for US-American otolaryngology patients treated following the introduction of healthcare quality programs like the National Surgical Quality Improvement Program (NSQIP) [6, 9, 14–16]. High-volume departments had also a higher overall readmission rate.…”

“…Readmission was planned in 4.9% and unplanned in 2.8% of the cases (Surgical cases alone: 2.6%). Former studies were mainly focused on surgical cases: Here, 30-day unplanned readmission rates vary from 5% to 20% [14–17]. The highest rates in otolaryngology patients are reported for head and neck cancer patients, especially following laryngectomy [15, 18, 19].…”

“…Due to the retrospective design, several parameters with possible association to unplanned readmission could not be analyzed due to a lack of sufficient data. For instance, in-hospital complications during the index admission seem to be a very strong predictor associated with 30-day readmission [6, 9, 14–16]. Furthermore, in head and neck cancer patients, cancer subsite, type of procedure, socioeconomic factors, comorbidities like coronary artery disease, chronic renal failure, or presence of a gastrostomy tube influence the risk of readmission [14, 16, 17].…”

Intercycle Unplanned Hospital Admissions Due to Cisplatin-based Chemotherapy Regimen-induced Adverse Reactions: A Retrospective Analysis

“…In addition, the readmission rate widely differs between types of cancer and different chemotherapy regimens. For example, previous studies have reported 22% readmission rate among patients with gastrointestinal cancers, 13.8% among patients with head and neck cancer, 4.3% among those who underwent lung cancer surgery and 52% in those who received etoposide, ifosfamide, and cisplatin [5, 19, 20]. To the best of our knowledge, ours is the first study of its kind in cancer patients who received cisplatin-based chemotherapy regimens.…”

Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival

“…To date, there have been many studies investigating short‐term morbidity and mortality associated with head and neck cancer surgeries, including TL. Such studies have investigated factors associated with need for reoperation, 11,12 30‐day unplanned readmission, 13‐18 30‐day mortality, 19 and prolonged inpatient LOS. Those investigating LOS include reviews of institutional 20 and national database 16,19,21 .…”