Predictors of returns to the emergency department after head and neck surgery

Baskin, Robert M.; Zhang, Jingnan; Dirain, Carolyn O.; Lipori, Paul; Fonseca, Gileno; Sawhney, Raja; Boyce, Brian; Silver, Natalie L.; Dziegielewski, Peter T.

doi:10.1002/hed.25019

Cited by 13 publications

(14 citation statements)

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“…31-34 Although not well studied, the rate of return ER visits after head and neck surgery has been reported as being 7.5%. 35 A conservative estimate of otolaryngologic surgeries performed per year is about 6 million, 36 which would suggest there are about 450,000 post-operative ER visits a year, of which about 60% are sent home. 35 It is thus imperative that effective methods are developed to reduce unnecessary unplanned ER visits.…”

Section: Discussionmentioning

confidence: 99%

Reducing ER Visits and Readmissions after Head and Neck Surgery Through a Phone-based Quality Improvement Program

Shah

Douglas

Carey

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: Evaluate the impact of a patient phone calls and virtual wound checks within 72 hours of discharge on reducing emergency room (ER) visits and readmissions. Methods: Single arm trial with comparison to historical control data of patients undergoing multi subsite head and neck cancer operations or laryngectomy between July 2017 and June 2018 at a tertiary academic medical center. Patients were contacted within 72 hours of hospital discharge. As a supplement to the call, patients were given the opportunity to video conference with and/or send pictures to the provider with additional questions via a designated wound care phone. Results: Ninety-one patients met inclusion criteria, of whom 83 (91.2%) were contacted. Six patients (7%) were readmitted, of whom three had not been able to be reached. The patients who had been unable to be contacted were readmitted for dysphagia (2), and a urinary tract infection (1). The contacted patients were advised to go the ER during the call for concerns for postoperative bleeding (2) and gastrointestinal bleeding (1). Twenty-five patients (30%) utilized the wound care phone. 18 patients (21.7%) reported that the phone call survey prevented them from going to the ER. When compared to the prior year, there was as statistically significant decrease in ER visits ( P < .05), and no change in readmissions. Conclusions: Implementation of a phone call in the early postoperative period has the potential to decrease unnecessary ER visits and enhance patient satisfaction. This may decrease strain on the health care system and improve patient care. Level of Evidence: Level 4

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Section: Discussionmentioning

confidence: 99%

Reducing ER Visits and Readmissions after Head and Neck Surgery Through a Phone-based Quality Improvement Program

Shah

Douglas

Carey

et al. 2020

Ann Otol Rhinol Laryngol

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“…[2][3][4] Prior studies performed in North American otorhinolaryngology -head and neck surgery departments seeking to identify risk factors for unplanned hospital readmission among patients undergoing otolaryngology procedures reported rates of hospital readmission ranging from 3.1 to 7.3%. 2,[4][5][6][7][8][9] These studies identified a strong association between the occurrence of postoperative complications and unplanned 30-day readmissions. 2,10 In another study that included 1,058 patients undergoing ear, nose, and throat (ENT) surgery, Graboyes et al found that patients who experienced a complication during or after their index hospitalization were 11.9 times more likely to be readmitted to the hospital within 30 days than patients without complications.…”

Section: Introductionmentioning

confidence: 99%

“…2 Regarding the reported 30-day readmission rates for head and neck surgery, it ranges from 3.2 to 26.5%, depending on the subsite, on the complexity of the surgery, and on a variety of factors. 2,3,[7][8][9]11,12 There is no data reported from European otorhinolaryngology -head and neck surgery departments about unplanned hospital readmission after head and neck surgery. Moreover, further understanding is needed about the risk factors associated with this.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Multivariant analysis of variables associated with readmission or visit to the emergency room 30-day Readmission 30-day visit to the ER Moreover, Bur et al performed a retrospective analysis including data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database looking for clinical risk factors and complications related to unplanned hospital readmission, reporting a rate of 5.1% of unplanned readmission in 2 years 16. More recently, Baskin et al highlighted the risk of return to the emergency room 30 days after surgery among patients who underwent head and neck surgery who needed to go to the intensive care unit 7. In another study, Goel et al demonstrated a higher rate of readmission in patients who underwent head and nek reconstruction after ablative surgery.…”

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confidence: 99%

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Unplanned Hospital Readmission and Visit to the Emergency Room in the First Thirty Days after Head and Neck Surgery: A Prospective, Single-center Study

Chiesa‐Estomba¹,

Sistiaga-Suárez²,

González-García³

et al. 2021

Int Arch Otorhinolaryngol

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Introduction Head and neck surgery remains a complex field; the patients can suffer important functional or life-threating complications after treatment that need unplanned readmissions, increasing the cost related to the treatment. Objective To evaluate the incidence risk factors and causes associated with 30-day unplanned hospital readmission and visit to the emergency room (ER) after surgery for head and neck cancer. Methods Prospective, longitudinal, nonrandomized study. Results A total of 834 patients were included, 726 in the major surgery group and 108 in the minor surgery group. The 30-day readmission rate for all causes was of 7,9% for the patients treated by a major surgery and of 0% for the patients treated in the outpatient clinic for minor procedures, to a total readmission rate of 6,8%. The rate of visit to the emergency room for all causes in the first 30 days was of 14% for the patients treated by a major surgery and of 2,7% for the patients treated in the outpatient clinic. Conclusion Major surgery, the American Society of Anesthesiologists (ASA) status and type of wound are conditions related to unplanned readmission or visit to the ER in the first 30 day after discharge. The most commonly associated causes are infections or wound complications. An evidence-based risk stratification of the patients can be important to improve decision-making and resource utilization. An educational strategy can provide possible ways to improve the rate of readmission and reduce the amount of money expended by healthcare systems.

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Healthcare Utilization of Oral and Oropharyngeal Cancer Patients in Emergency Department and Outpatient Settings: An 8‐year Population‐Based Study

MiriMoghaddam,

Bohlouli,

Lai

et al. 2024

Head & Neck

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IntroductionThis study aimed to determine trends in the healthcare utilization by Oral Cavity and Oropharyngeal cancer patients across emergency department (ED) and outpatient settings in Alberta and examine the predictors of ED visits.MethodsThis is a retrospective, population‐based, cohort study using administrative data collected by all healthcare facilities between 2010 and 2019 in Alberta, Canada. Trend of visits to different facilities, patients' primary diagnosis, and predictors of ED visits were analyzed.ResultsIn total, 34% of patients had at least one cancer‐related ED visit. With a rise of 31% in cancer incidence, there was a notable upswing in visits to outpatient clinics and community offices, while ED visits decreased. Cancer stage, rural residence, high material deprivation score, and treatments were found as predictors of ED visits.ConclusionImproved symptom management and better care access for disadvantaged and rural oral cancer patients may decrease avoidable ED visits.

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Predictors of returns to the emergency department after head and neck surgery

Abstract: The rate of 30dEDRs after head and neck surgery is low; however, these visits increase the hospitals' financial burden as well as patient morbidity. Predictors of 30dEDRs may be utilized to formulate preventative measures.

Cited by 13 publications

References 50 publications

Reducing ER Visits and Readmissions after Head and Neck Surgery Through a Phone-based Quality Improvement Program

Reducing ER Visits and Readmissions after Head and Neck Surgery Through a Phone-based Quality Improvement Program

Unplanned Hospital Readmission and Visit to the Emergency Room in the First Thirty Days after Head and Neck Surgery: A Prospective, Single-center Study

Healthcare Utilization of Oral and Oropharyngeal Cancer Patients in Emergency Department and Outpatient Settings: An 8‐year Population‐Based Study

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