Prevalence And Risk Factors For 30 Day Readmissions Following Free Flap Reconstruction For Head And Neck Cancer
Anaeze C. Offodile, Jr., M.D.1, Abraham Pathak, M.D.2, Charles Norris, Jr., M.D.2, Dennis Orgill, M.D, Ph.D2, Lifei Guo, MD, PhD, FACS1.
1Lahey Hospital and Medical Center, Burlington, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA.
Purpose: Hospital readmissions are under intense scrutiny as a metric of health-care quality. Our study provides a comprehensive analysis of 30 day readmissions in head and neck cancer patients who underwent free-flap reconstruction, with the aim of highlighting predictive risk factors.
Methods: A single-institution retrospective review was performed of all patients who underwent microvascular reconstruction following head and neck oncologic extirpation. Univariate and multivariate analyses were employed to identify risk factors related to 30 day readmissions, controlling for co-morbidities and demographics.
Results: Two hundred and forty nine consecutive patients over a 16 year-period were included in the study, of whom 36 were readmitted within 30 days at a rate of 14.5%. The most common indications for readmission were fistula and neck wound complications. The most significant predictors of readmission were advanced pathologic tumor stages (T3: OR 9.92, p=0.04 & T4: OR 8.92, p=0.04) & tumor location (larynx: OR 10.12, p=0.002 & hypopharynx: OR 10.12, p=0.007). Readmitted patients had higher rates of the following complications: total flap loss (OR 9.74, p=0.007) and fistula complications (OR 4.11, p=0.02). Readmission was also associated with a longer LOS during the index hospitalization (11 days IQR 9-20 vs. 10 days IQR 8-13, p=0.03) and increased likelihood of re-operation (55.6% vs. 0.9%, p<0.001).
Conclusions: This study is the first to identify advanced pathologic tumor staging and tumor location as significant predictors of 30 day readmission. It imparts a benchmark for comparison and a basis for risk-stratification to build upon in system-based practices.
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