Readmission after surgery for oropharyngeal cancer: An analysis of rates, causes, and risk factors.

ABSTRACT

OBJECTIVES/HYPOTHESIS: Determine the rate, diagnoses, and risk factors associated with 30-day nonelective readmissions for patients undergoing surgery for oropharyngeal cancer. STUDY DESIGN: Retrospective cohort study. METHODS: We analyzed the Nationwide Readmissions Database for patients who underwent oropharyngeal cancer surgery between 2010 and 2014. Rates and causes of 30-day readmissions were determined. Multivariate logistic regression was used to identify risk factors for readmission. RESULTS: Among 16,902 identified cases, the 30-day, nonelective readmission rate was 10.2%, with an average cost per readmission of $14,170. The most common readmission diagnoses were postoperative bleeding (14.1%) and wound complications (12.6%) (surgical site infection [8.6%], dehiscence [2.3%], and fistula [1.7%]). On multivariate regression, significant risk factors for readmission were major ablative surgery (which included total glossectomy, pharyngectomy, and mandibulectomy) (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.06-1.60), advanced Charlson/Deyo comorbidity (OR 2.00, 95% CI 1.43-2.79), history of radiation (OR 1.58, 95% CI 1.15-2.17), Medicare (OR 1.34, 95% CI 1.06-1.69) or Medicaid (OR 1.82, 95% CI 1.32-2.50) payer status, index admission from the emergency department (OR 1.19, 95% CI 1.02-1.40), and length of stay ≥6 days (OR 1.57, 95% CI 1.19-2.08). CONCLUSIONS: In this large database analysis, we found that approximately one in 10 patients undergoing surgery for oropharyngeal cancer is readmitted within 30 days. Procedural complexity, insurance status, and advanced comorbidity are independent risk factors, whereas postoperative bleeding and wound complications are the most common reasons for readmission. LEVEL OF EVIDENCE 4. Laryngoscope, 129910-918, 2019.