Postoperative care fragmentation and thirty-day unplanned readmissions after head and neck cancer surgery

作者：Graboyes Evan M^*; Kallogjeri Dorina; Saeed Mohammed J; Olsen Margaret A; Nussenbaum Brian

来源：Laryngoscope, 2017, 127(4): 868-874.

DOI：10.1002/lary.26301

• Readmissions
• unplanned readmission
• quality
• care fragmentation
• State Inpatient Database
• head and neck cancer
• healthcare policy

Objectives/HypothesisPostdischarge care fragmentation, readmission to a hospital other than the one performing the surgery, has not been described in head and neck cancer patients. We sought to determine the frequency, risk factors, and outcomes for head and neck cancer patients experiencing postdischarge care fragmentation.
Study DesignRetrospective cohort study.
MethodsWe analyzed patients in the 2008 to 2010 California State Inpatient Database with a 30-day unplanned readmission following head and neck cancer surgery. The frequency of postdischarge care fragmentation, patient- and hospital-level risk factors for care fragmentation, readmission diagnosis, and readmission outcomes were determined.
ResultsOf 561 patients with a 30-day unplanned readmission, 210 (37.4%) were readmitted to a hospital other than the one performing the surgery. Surgical hospitalization length of stay 15 days (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.13-3.10) and discharge to a care facility (OR: 2.85, 95% CI: 1.77-4.58) were associated with care fragmentation. Overall, 39.8% of unplanned 30-day readmissions (223/561) were treatment complications, and 30.9% of treatment complication readmissions (69/223) occurred at a nonindex hospital. Patients with postdischarge care fragmentation had a 2.1-fold increased risk of in-hospital mortality within 30 days of readmission compared to patients readmitted to the index hospital (95% CI: 1.04-4.26).
ConclusionsPostdischarge care fragmentation following head an neck cancer surgery is common, as 37% of readmitted patients and 31% of patients readmitted with a treatment complication are readmitted to a hospital other than the surgical hospital. Head and neck cancer patients experiencing care fragmentation are at increased risk of in-hospital mortality within 30 days of readmission.
Level of Evidence4. Laryngoscope, 127:868-874, 2017

• 出版日期2017-4