Risk factors for unplanned readmission in total laryngectomy patients

Vimawala, Swar; Topf, Michael C.; Savard, Corey; Keane, William M.; Luginbuhl, Adam; Goldman, Richard; Cognetti, David M.; Curry, Joseph

doi:10.1002/lary.28255

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…Interestingly, they found that prior history of radiation did not increase the risk of readmission. 12 By contrast, the present study identified the oral cavity and pharynx as the most common site of index surgery in patients who experienced unplanned readmission. Similarly, in a large state-wide…”

Section: Discussioncontrasting

confidence: 67%

Analysis of Otolaryngologic Readmissions at a High‐Volume Quaternary Referral Center

Godse

Snyderman

2023

The Laryngoscope

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ObjectivesTo identify common reasons for readmission following otolaryngologic surgery at a high‐volume center and identify possible risk factors for readmission.MethodsRetrospective chart review of readmissions identified by hospital‐based electronic medical record reporting mechanism.ResultsFrom January 2019 to September 2020, there were 87 readmissions following 808 index surgeries. The most common reason for readmission was for planned surgery (23%), followed by post‐operative neck infection, bleeding, or pneumonia. Patients with unplanned readmissions had significantly longer index admission duration than patients who were not readmitted (median 7 days vs. median 5 days, resp.; p = 0.0056). Analysis of cases of unplanned readmission for neck infection and bleeding identified the oral cavity/pharynx as the most common site of initial surgery and that a majority of patients had a history of radiation therapy.ConclusionNeck infection, bleeding, and pneumonia were the most common reasons for unplanned readmission following otolaryngologic surgery, and a large portion of patients required additional procedures during readmission. Unplanned readmissions for bleeding were significantly more costly than readmissions for neck infections. Long‐index hospitalizations, index surgery involving the oral cavity and pharynx, and a history of radiation therapy may be useful clinical features that could stratify the risk of readmission.Level of Evidence4, retrospective chart review Laryngoscope, 133:2546–2552, 2023

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Section: Discussioncontrasting

confidence: 67%

Analysis of Otolaryngologic Readmissions at a High‐Volume Quaternary Referral Center

Godse

Snyderman

2023

The Laryngoscope

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“…Previous studies that have examined prolonged inpatient hospitalization after TL have been limited to short‐term follow‐up information, such as 30‐day readmission, need for return to the OR, and short‐term mortality 16,18,19,21 . These studies have used datasets, such as the NSQIP and National Inpatient Sample, 16,21 that have advantages for short‐term endpoints, but do not contain the oncologic information or long‐term follow‐up information encoded by a dataset such as the NCDB.…”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the most common complication after TL in patients with reconstruction was wound infection (15.6%) 19 . Wound infection and pharyngocutaneous fistula are associated with higher rates of unplanned readmission within 30‐days of discharge 16,18 . Finally, use of the National Inpatient Sample database has demonstrated that high‐volume facilities have lower rates of complications and shorter LOS in patients undergoing laryngectomy 21 …”

Section: Introductionmentioning

confidence: 99%

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

Jacobs

Kafle

Earles

et al. 2021

Laryngoscope Investig Oto

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Objectives To investigate factors and complications associated with prolonged inpatient length of stay (LOS) in patients who receive total laryngectomy (TL), and to analyze its effect on short‐term and long‐term overall survival (OS). Methods The National Cancer Database (NCDB) was queried from 2004 to 2016 for patients with laryngeal cancer, who received TL within 60 days of diagnosis, and who had an inpatient LOS ≥1 night. Multivariable binary logistic regression and survival analyses on propensity score matched cohorts with Kaplan‐Meier analysis and extended Cox regression were utilized. Results Eight thousand two hundred and ninety‐eight patients from the NCDB were included. Median inpatient LOS was 8 days after TL (IQR: 7, 12). Prolonged LOS was defined as above the 75th percentile or 13 days or greater. On multivariable analysis, increasing patient age (OR 1.14 per 10 years, P = .003), female sex (OR 1.35, P < .001), and Charlson‐Deyo comorbidity score of ≥2 compared to a score of 0 (OR 1.43, P < .001) were associated with prolonged LOS. Patients treated at high surgical case volume centers had a decreased likelihood for prolonged LOS (OR 0.67, P < .001). Ninety‐day mortality increased over time in patients who stayed ≥13 days. Prolonged LOS was independently associated with worse OS on multivariable analysis (HR 1.40, 95% CI: 1.22, 1.61) in a matched cohort. Conclusions Prolonged LOS after TL serves as a strong indicator for postoperative long‐term mortality and may help identify patients who warrant closer surveillance. Level of Evidence 3.

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“…[6][7][8] Furthermore, studies have shown that the 30-day readmission rate of patients after PCI ranges from 4.7% to 22.0%. 9,10 However, the 30-day readmission rate may be underestimated because readmissions can also occur at a hospital other than that of the index admission.…”

Section: Introductionmentioning

confidence: 99%

Predicting the Risk of Unplanned Readmission at 30 Days After PCI: Development and Validation of a New Predictive Nomogram

Xu¹,

Tu²,

Xiong³

et al. 2022

CIA

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This study aimed to develop and validate a risk prediction model that can be used to identify percutaneous coronary intervention (PCI) patients at high risk for 30-day unplanned readmission. Patients and Methods:We developed a prediction model based on a training dataset of 1348 patients after PCI. The data were collected from January 2020 to December 2020. Clinical characteristics, laboratory data and risk factors were collected using the hospital database. The LASSO regression method was applied to filter variables and select predictors, and feature selection for a 30day readmission risk model was optimized using least absolute shrinkage. Multivariate logistic regression was used to construct a nomogram. The performance and clinical utility of the nomogram were evaluated with a receiver operating characteristic (ROC) curve, a calibration curve, and decision curve analysis (DCA). Internal validation of the predictive accuracy was performed using bootstrapping validation. Results: The predictors included in the prediction nomogram were medical insurance, length of stay, left ventricular ejection fraction on admission, history of hypertension, the presence of chronic lung disease, the presence of anemia, and serum creatinine level on admission. The area under the receiver operating characteristic curve for the predictive model was 0.735 (95% CI: 0.711-0.759). The P value of the Hosmer-Lemeshow goodness of fit test was 0.326, indicating good calibration, and the calibration curves showed good agreement between the classifications and actual observations. DCA also demonstrated that the nomogram was clinically useful. A high c-index value of 0.723 was obtained during the internal validation. Conclusion:We developed an easy-to-use nomogram model to predict the risk of readmission 30 days after discharge for PCI patients. This risk prediction model may serve as a guide for screening high-risk patients and allocating resources for PCI patients at the time of hospital discharge and may provide a reference for preventive care interventions.

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Risk factors for unplanned readmission in total laryngectomy patients

Cited by 8 publications

References 26 publications

Analysis of Otolaryngologic Readmissions at a High‐Volume Quaternary Referral Center

Analysis of Otolaryngologic Readmissions at a High‐Volume Quaternary Referral Center

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

Predicting the Risk of Unplanned Readmission at 30 Days After PCI: Development and Validation of a New Predictive Nomogram

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