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

Abstract

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

National Trends in 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

“…In addition to surgical techniques discussed herein, demographics and medical comorbidities were associated with postoperative readmissions. We found that male sex was associated with increased risk of readmission, which is consistent with the literature both in TORS and in all patients with head and neck cancer . We also found that a history of congestive heart failure placed patients undergoing TORS at more than a 2-fold increased risk of readmission, which is consistent with previous studies demonstrating congestive heart failure as a risk factor for readmission in all patients with head and neck cancer, as well as patients undergoing free flap reconstruction …”

“…The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes for oropharyngeal sites of cancer or tonsil cancer and procedure codes for robotic and oropharyngeal surgery were used to include patients (see the eAppendix in Supplement 1 for a complete list of diagnosis and procedure codes). Similar to other reports using this database, patient records missing information on index or readmissions, transfers, or patients who died during index admission or left against medical advice were not included in this analysis.…”