Author(s)
Michelle Pei BS
Mark Swanson MD
Affiliation(s)
USC Keck School of Medicine;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to identify risk factors for 30 day readmissions after HNCA surgeries.
Objectives: 30 day readmissions have significant impacts on healthcare costs, patient outcomes, and are increasingly being used as a measure of quality of care. Studies evaluating surgical HNCA patients on a nationwide scale have been sparse. Our goal is to describe risk factors, causes, and comorbidities of 30 day readmissions in patients with HNCA following surgery.
Study Design: A retrospective cohort study.
Methods: Using the Nationwide Readmissions Database (2014), identifying HNCA patients who were readmitted within 30 days following related surgery.
Results: Within 30 days, 351 (16.56%) of 2119 patients were readmitted. 30% of readmissions were wound related (infection, wound dehiscence, fistula, and other graft complications). Patients from lower household income zip codes were generally more likely to be readmitted (OR 1.30, 95% CI 1.11-1.51), and they were more likely to be readmitted due to wound related complications (OR 1.36, 95% CI 1.00-1.85). Medicaid patients were more likely to be readmitted (OR 1.39, 95% CI 1.19-1.62) than Medicare, private insurance, and self-pay patients. Comorbidities correlated to significantly higher risks of readmission include: congestive heart failure (OR 1.57, 95% CI 1.24-1.98), chronic pulmonary disease (OR 1.41, 95% CI 1.24-1.60), complicated diabetes mellitus (OR 1.70, 95% CI 1.20-2.42), and liver disease (OR 1.71, 95% CI 1.19-2.46).
Conclusions: Consistent with a similar study done using the 2013 NRD1, 30 day readmissions after HNCA surgery remained near 16% in 2014 and are commonly due to wound related complications. Lower SES (socioeconomic status) patients were generally at higher risk of readmission and of developing wound related complications.