Hospital stay following complex major head and neck resection: what factors play a role?

Tadiparthi, Sujatha; Enache, A; Kalidindi, Kalyan Kumar Varma; O’Hara, James; Paleri, Vinidh

doi:10.1111/coa.12250

Cited by 14 publications

(14 citation statements)

References 17 publications

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“…This is comparable to another Australian study (median LOS of 29 days) but much longer than the LOS reported from studies in the USA, Canada and UK . The LOS following laryngectomy is affected by both patient and health service factors . These factors include: available healthcare resources, established care pathways, the availability of appropriate patient support services close to the patient's home and inpatient versus outpatient care models .…”

Section: Discussionsupporting

confidence: 66%

“…The LOS following laryngectomy is affected by both patient and health service factors . These factors include: available healthcare resources, established care pathways, the availability of appropriate patient support services close to the patient's home and inpatient versus outpatient care models . In our study, there was significant disagreement between LOS predicted by the ACS‐NSQIP calculator and actual LOS.…”

Section: Discussionmentioning

confidence: 66%

“…Thirty percent of patients in this study required primary reconstruction at the time of laryngectomy, and this was associated with prolonged LOS. Advanced tumours or those in anatomically unfavourable locations required longer surgery and additional operative time for reconstruction, which are both associated with more frequent post‐operative complications and increased LOS . Seventy percent of patients who underwent a reconstructive procedure experienced some form of complication.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

National Surgical Quality Improvement Program risk calculator validity in South Australian laryngectomy patients

Kao

Frauenfelder

Wong

et al. 2020

ANZ Journal of Surgery

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Background: Assessing an individual patient's post-operative risk profile prior to laryngectomy for cancer is difficult. The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) risk calculator was developed to better inform preoperative decision-making. The calculator uses patient-specific characteristics to estimate the risk of experiencing post-operative complications within 30 days of surgery. We investigated the ACS-NSQIP risk calculator's performance for Australian laryngectomy patients. Methods: The ACS-NSQIP risk calculator was used to retrospectively calculate the 30-day post-operative predicted outcomes in patients who underwent laryngectomy for laryngeal, hypopharyngeal and thyroid cancers (with laryngeal involvement) in two institutions in South Australia. These data were compared against the actual mortality, morbidity, complications and length of stay (LOS) collected from a retrospective chart review. Results: A total of 144 patients underwent surgical intervention for malignancies with laryngeal involvement. The median LOS was 25 days (range 13-197) compared to the predicted LOS of 6.5 days (range 3.5-12.5). Overall mortality was 2.78% with postoperative complications occurring in 63% of patients. The most common complication was wound infection, occurring in 33% of patients. Hosmer-Lemeshow plots demonstrated good agreement between predicted and observed rates for complications. Conclusion: The ACS-NSQIP risk calculator effectively predicted post-operative complication rates in South Australian laryngeal cancer patients undergoing laryngectomy. However, differences in predicted and actual LOS may limit the usefulness of the calculator's LOS predictions for Australian patients. © 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 740-745 ANZJSurg.com

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

National Surgical Quality Improvement Program risk calculator validity in South Australian laryngectomy patients

Kao

Frauenfelder

Wong

et al. 2020

ANZ Journal of Surgery

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“…Numerous analyses of large-scale databases of head and neck surgery patients have found expected factors associated with prolonged total LOS, such as older age, poorer functional status, alcohol consumption, increased comorbidities, longer operative time, blood transfusion, operative complications, wound types, preoperative radiation therapy (RT) (.60 Gy). [16][17][18][19][20] While these factors may influence the LOS up to the date eligible for DC, they are unlikely to lead to delays in DC once the patient is medically fit to leave the hospital. The current results reflect this as no comorbidities predicted DC delay (P .…”

Section: Discussionmentioning

confidence: 99%

“…This association potentially demonstrates patients with more complex surgical cases and medical conditions as well as social situations. [16][17][18][19][20] The magnitude of DC delay in these patients was nearly a week and suggests that by optimizing the medically necessary LOS, DC delays could be decreased.…”

Section: Discussionmentioning

confidence: 99%

Discharge Delay in Head and Neck Free Flap Surgery: Risk Factors and Strategies to Minimize Hospital Days

Lang

Danan

Sawhney

et al. 2019

Otolaryngol.--head neck surg.

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Objective Length of stay (LOS) includes time medically necessary in the hospital and time waiting for discharge (DC) afterward. This DC delay is determined in head and neck free flap patients. Reasons for and factors leading to DC delay, as well as associated adverse outcomes, are elucidated. Methods Retrospective chart review was performed for all head and neck free flap surgeries from 2012 to 2017. Data including demographics, comorbidities, and perioperative factors were collected. Regression analyses were performed to identify factors associated with DC delay. Results In total, 264 patients were included. Mean total LOS was 13.1 days. DC delay occurred in 65% of patients with a mean of 4.8 days. Factors associated with DC delay on univariate analysis included Medicaid/self-pay insurance, DC to a facility, and not having children (P < .05). Multivariate analysis showed prolonged medically necessary LOS and surgery on a Monday/Friday (P < .05) were associated with DC delay. Top reasons for DC delay included case management shortages, rejection by facility, and awaiting supplies. Eleven percent experienced complications during the DC delay. Discussion DC delay can add days and complications to the LOS. Prevention begins preoperatively with DC planning involving the patient’s closest family. Understanding limitations of the patient’s insurance may help plan DC destination. Optimizing hospital resources when available should be a focus. Implications for Practice Head and neck free flap patients require a team of teams unified in optimizing quality of care. DC delay is a novel quality metric reflecting the team’s overall performance. Through strategic DC planning and capitalizing on available resources, DC delay can be minimized.

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Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions

Gao

Nuyen

Divi

et al. 2018

JAMA Otolaryngol Head Neck Surg

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Because of limited patient life expectancies, modest functional and aesthetic outcomes, and significant associated costs, surgeons should weigh the curative potential and palliative benefits for individual patients with a comprehensive view of the overall outcomes of extensive head and neck resections and reconstructions. Realistic expectations should be emphasized during preoperative discussions with patients.

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Hospital stay following complex major head and neck resection: what factors play a role?

Cited by 14 publications

References 17 publications

National Surgical Quality Improvement Program risk calculator validity in South Australian laryngectomy patients

National Surgical Quality Improvement Program risk calculator validity in South Australian laryngectomy patients

Discharge Delay in Head and Neck Free Flap Surgery: Risk Factors and Strategies to Minimize Hospital Days

Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions

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