Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck

Heather A. Osborn, Vinay K. Rathi, Tjoson Tjoa, Neerav Goyal, Bharat B. Yarlagadda, Debbie L. Rich, Kevin S. Emerick, Derrick T. Lin, Daniel G. Deschler, Marlene L. Durand

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: Unplanned 30-day readmission rate following hospital discharge is an important metric of healthcare quality. This study sought to characterize the rate, risk factors, and common causes of readmission in head and neck cancer patients following free or pedicled flap reconstruction. Study Design: Retrospective cohort study. Methods: Charts were reviewed of all patients who underwent free or pedicled flap reconstruction following resection of head and neck cancer at the Massachusetts Eye and Ear Infirmary 2009 to 2014. Readmission risk factors were evaluated by univariate and multivariate analysis. Results: Of 682 patients with free (76%) or pedicled flap reconstruction, 135 patients (19.8%) were readmitted. Factors not associated with readmission included age, gender, American Society of Anesthesiologists status, operative time, prior radiation therapy, primary cancer site, and free (vs. pedicled) flap type. Significant readmission risk factors included surgical site infections (SSI) (45.2% vs. 9.9%), use of hardware (18.5% vs. 11.3%), and clean–contaminated or contaminated surgery (15.2% vs. clean 8.2%). Surgical site infections (P < 0.001) and use of hardware (P = 0.03) remained predictive of readmission on multiple regression analysis. Primary reasons for readmission included wound complications (61.5%) and supportive care (15.6%). The median time to readmission was 8 days, and 41% of readmissions occurred within 1 week. Seventy percent of readmissions occurred within 2 weeks, including 77% of readmissions for SSIs and 86% for supportive care. Conclusion: Readmissions occurred in nearly one-fifth of patients following flap surgery. SSIs and use of hardware were risk factors, whereas wound complications were the most common cause of readmission. Level of Evidence: 4. Laryngoscope, 128:343–349, 2018.

Original languageEnglish (US)
Pages (from-to)343-349
Number of pages7
JournalLaryngoscope
Volume128
Issue number2
DOIs
StatePublished - Feb 1 2018

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Surgical Flaps
Neck
Head
Free Tissue Flaps
Surgical Wound Infection
Head and Neck Neoplasms
Laryngoscopes
Quality of Health Care
Wounds and Injuries
Operative Time
Ear
Cohort Studies
Radiotherapy
Multivariate Analysis
Retrospective Studies
Regression Analysis
Neoplasms

All Science Journal Classification (ASJC) codes

  • Otorhinolaryngology

Cite this

Osborn, H. A., Rathi, V. K., Tjoa, T., Goyal, N., Yarlagadda, B. B., Rich, D. L., ... Durand, M. L. (2018). Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck. Laryngoscope, 128(2), 343-349. https://doi.org/10.1002/lary.26726
Osborn, Heather A. ; Rathi, Vinay K. ; Tjoa, Tjoson ; Goyal, Neerav ; Yarlagadda, Bharat B. ; Rich, Debbie L. ; Emerick, Kevin S. ; Lin, Derrick T. ; Deschler, Daniel G. ; Durand, Marlene L. / Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck. In: Laryngoscope. 2018 ; Vol. 128, No. 2. pp. 343-349.
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abstract = "Objectives: Unplanned 30-day readmission rate following hospital discharge is an important metric of healthcare quality. This study sought to characterize the rate, risk factors, and common causes of readmission in head and neck cancer patients following free or pedicled flap reconstruction. Study Design: Retrospective cohort study. Methods: Charts were reviewed of all patients who underwent free or pedicled flap reconstruction following resection of head and neck cancer at the Massachusetts Eye and Ear Infirmary 2009 to 2014. Readmission risk factors were evaluated by univariate and multivariate analysis. Results: Of 682 patients with free (76{\%}) or pedicled flap reconstruction, 135 patients (19.8{\%}) were readmitted. Factors not associated with readmission included age, gender, American Society of Anesthesiologists status, operative time, prior radiation therapy, primary cancer site, and free (vs. pedicled) flap type. Significant readmission risk factors included surgical site infections (SSI) (45.2{\%} vs. 9.9{\%}), use of hardware (18.5{\%} vs. 11.3{\%}), and clean–contaminated or contaminated surgery (15.2{\%} vs. clean 8.2{\%}). Surgical site infections (P < 0.001) and use of hardware (P = 0.03) remained predictive of readmission on multiple regression analysis. Primary reasons for readmission included wound complications (61.5{\%}) and supportive care (15.6{\%}). The median time to readmission was 8 days, and 41{\%} of readmissions occurred within 1 week. Seventy percent of readmissions occurred within 2 weeks, including 77{\%} of readmissions for SSIs and 86{\%} for supportive care. Conclusion: Readmissions occurred in nearly one-fifth of patients following flap surgery. SSIs and use of hardware were risk factors, whereas wound complications were the most common cause of readmission. Level of Evidence: 4. Laryngoscope, 128:343–349, 2018.",
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Osborn, HA, Rathi, VK, Tjoa, T, Goyal, N, Yarlagadda, BB, Rich, DL, Emerick, KS, Lin, DT, Deschler, DG & Durand, ML 2018, 'Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck', Laryngoscope, vol. 128, no. 2, pp. 343-349. https://doi.org/10.1002/lary.26726

Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck. / Osborn, Heather A.; Rathi, Vinay K.; Tjoa, Tjoson; Goyal, Neerav; Yarlagadda, Bharat B.; Rich, Debbie L.; Emerick, Kevin S.; Lin, Derrick T.; Deschler, Daniel G.; Durand, Marlene L.

In: Laryngoscope, Vol. 128, No. 2, 01.02.2018, p. 343-349.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck

AU - Osborn, Heather A.

AU - Rathi, Vinay K.

AU - Tjoa, Tjoson

AU - Goyal, Neerav

AU - Yarlagadda, Bharat B.

AU - Rich, Debbie L.

AU - Emerick, Kevin S.

AU - Lin, Derrick T.

AU - Deschler, Daniel G.

AU - Durand, Marlene L.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objectives: Unplanned 30-day readmission rate following hospital discharge is an important metric of healthcare quality. This study sought to characterize the rate, risk factors, and common causes of readmission in head and neck cancer patients following free or pedicled flap reconstruction. Study Design: Retrospective cohort study. Methods: Charts were reviewed of all patients who underwent free or pedicled flap reconstruction following resection of head and neck cancer at the Massachusetts Eye and Ear Infirmary 2009 to 2014. Readmission risk factors were evaluated by univariate and multivariate analysis. Results: Of 682 patients with free (76%) or pedicled flap reconstruction, 135 patients (19.8%) were readmitted. Factors not associated with readmission included age, gender, American Society of Anesthesiologists status, operative time, prior radiation therapy, primary cancer site, and free (vs. pedicled) flap type. Significant readmission risk factors included surgical site infections (SSI) (45.2% vs. 9.9%), use of hardware (18.5% vs. 11.3%), and clean–contaminated or contaminated surgery (15.2% vs. clean 8.2%). Surgical site infections (P < 0.001) and use of hardware (P = 0.03) remained predictive of readmission on multiple regression analysis. Primary reasons for readmission included wound complications (61.5%) and supportive care (15.6%). The median time to readmission was 8 days, and 41% of readmissions occurred within 1 week. Seventy percent of readmissions occurred within 2 weeks, including 77% of readmissions for SSIs and 86% for supportive care. Conclusion: Readmissions occurred in nearly one-fifth of patients following flap surgery. SSIs and use of hardware were risk factors, whereas wound complications were the most common cause of readmission. Level of Evidence: 4. Laryngoscope, 128:343–349, 2018.

AB - Objectives: Unplanned 30-day readmission rate following hospital discharge is an important metric of healthcare quality. This study sought to characterize the rate, risk factors, and common causes of readmission in head and neck cancer patients following free or pedicled flap reconstruction. Study Design: Retrospective cohort study. Methods: Charts were reviewed of all patients who underwent free or pedicled flap reconstruction following resection of head and neck cancer at the Massachusetts Eye and Ear Infirmary 2009 to 2014. Readmission risk factors were evaluated by univariate and multivariate analysis. Results: Of 682 patients with free (76%) or pedicled flap reconstruction, 135 patients (19.8%) were readmitted. Factors not associated with readmission included age, gender, American Society of Anesthesiologists status, operative time, prior radiation therapy, primary cancer site, and free (vs. pedicled) flap type. Significant readmission risk factors included surgical site infections (SSI) (45.2% vs. 9.9%), use of hardware (18.5% vs. 11.3%), and clean–contaminated or contaminated surgery (15.2% vs. clean 8.2%). Surgical site infections (P < 0.001) and use of hardware (P = 0.03) remained predictive of readmission on multiple regression analysis. Primary reasons for readmission included wound complications (61.5%) and supportive care (15.6%). The median time to readmission was 8 days, and 41% of readmissions occurred within 1 week. Seventy percent of readmissions occurred within 2 weeks, including 77% of readmissions for SSIs and 86% for supportive care. Conclusion: Readmissions occurred in nearly one-fifth of patients following flap surgery. SSIs and use of hardware were risk factors, whereas wound complications were the most common cause of readmission. Level of Evidence: 4. Laryngoscope, 128:343–349, 2018.

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