Patients undergoing total laryngectomy: An at-risk population for 30-day unplanned readmission

Evan M. Graboyes, Zao Yang, Dorina Kallogjeri, Jason A. Diaz, Brian Nussenbaum

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Patients undergoing total laryngectomy are at high risk for hospital readmission. Hospital readmissions are increasingly scrutinized because they are used as a metric of quality care and are subject to financial penalties. OBJECTIVE: To determine the rate of, reasons for, and risk factors that predict 30-day unplanned readmission for patients undergoing total laryngectomy. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study at a single academic tertiary referral medical center. The study population comprised 155 patients who underwent total laryngectomy with or without flap closure between January 2007 and December 2012 as either a primary treatment or salvage treatment for prior nonsurgical management. INTERVENTIONS: Total laryngectomy. MAIN OUTCOMES AND MEASURES: Rate of 30-day unplanned readmission, readmission diagnoses, and risk factors for unplanned readmission. Univariable and multivariable logistic regression were performed to identify risk factors for unplanned readmission within 30 days of discharge. RESULTS: The 30-day unplanned readmission rate for patients following discharge after total laryngectomy was 26.5%(41 of 155). The most common readmission diagnoses were pharyngocutaneous fistula (27%of readmissions; n = 11) and stomal cellulitis (16%of readmissions; n = 7). The median time to unplanned readmission was 7 days. Thirty-four percent of readmissions (14 of 41) occurred within 3 days of discharge. Significant predictors of 30-day unplanned readmission on multivariable analysis were postoperative complication after discharge (odds ratio [OR], 11.50; 95%CI, 4.10-32.28), visit to the emergency department within 30 days after discharge (OR, 5.25; 95%CI, 1.84-14.99), salvage total laryngectomy (OR, 3.52; 95%CI, 1.56-13.12), and chyle fistula during the index hospitalization (OR, 5.25; 95%CI, 0.86-29.92). The discriminative ability of the model to predict unplanned readmission, as measured by the C statistic, was 0.88. CONCLUSIONS AND RELEVANCE: Patients undergoing total laryngectomy are an at-risk patient population with a high rate of unplanned readmission within 30 days of discharge. By identifying the risk factors that predict 30-day unplanned readmission, these data can be used to design and implement quality-improvement interventions to decrease readmissions.

Original languageEnglish (US)
Pages (from-to)1157-1165
Number of pages9
JournalJAMA Otolaryngology - Head and Neck Surgery
Volume140
Issue number12
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

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Laryngectomy
Patient Readmission
Odds Ratio
Fistula
Chyle
Salvage Therapy
Cellulitis
Patient Discharge
Quality of Health Care
Quality Improvement
Tertiary Care Centers
Hospital Emergency Service
Hospitalization
Cohort Studies
Retrospective Studies
Logistic Models
Population

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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Patients undergoing total laryngectomy : An at-risk population for 30-day unplanned readmission. / Graboyes, Evan M.; Yang, Zao; Kallogjeri, Dorina; Diaz, Jason A.; Nussenbaum, Brian.

In: JAMA Otolaryngology - Head and Neck Surgery, Vol. 140, No. 12, 01.12.2014, p. 1157-1165.

Research output: Contribution to journalArticle

Graboyes, Evan M. ; Yang, Zao ; Kallogjeri, Dorina ; Diaz, Jason A. ; Nussenbaum, Brian. / Patients undergoing total laryngectomy : An at-risk population for 30-day unplanned readmission. In: JAMA Otolaryngology - Head and Neck Surgery. 2014 ; Vol. 140, No. 12. pp. 1157-1165.
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abstract = "IMPORTANCE: Patients undergoing total laryngectomy are at high risk for hospital readmission. Hospital readmissions are increasingly scrutinized because they are used as a metric of quality care and are subject to financial penalties. OBJECTIVE: To determine the rate of, reasons for, and risk factors that predict 30-day unplanned readmission for patients undergoing total laryngectomy. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study at a single academic tertiary referral medical center. The study population comprised 155 patients who underwent total laryngectomy with or without flap closure between January 2007 and December 2012 as either a primary treatment or salvage treatment for prior nonsurgical management. INTERVENTIONS: Total laryngectomy. MAIN OUTCOMES AND MEASURES: Rate of 30-day unplanned readmission, readmission diagnoses, and risk factors for unplanned readmission. Univariable and multivariable logistic regression were performed to identify risk factors for unplanned readmission within 30 days of discharge. RESULTS: The 30-day unplanned readmission rate for patients following discharge after total laryngectomy was 26.5{\%}(41 of 155). The most common readmission diagnoses were pharyngocutaneous fistula (27{\%}of readmissions; n = 11) and stomal cellulitis (16{\%}of readmissions; n = 7). The median time to unplanned readmission was 7 days. Thirty-four percent of readmissions (14 of 41) occurred within 3 days of discharge. Significant predictors of 30-day unplanned readmission on multivariable analysis were postoperative complication after discharge (odds ratio [OR], 11.50; 95{\%}CI, 4.10-32.28), visit to the emergency department within 30 days after discharge (OR, 5.25; 95{\%}CI, 1.84-14.99), salvage total laryngectomy (OR, 3.52; 95{\%}CI, 1.56-13.12), and chyle fistula during the index hospitalization (OR, 5.25; 95{\%}CI, 0.86-29.92). The discriminative ability of the model to predict unplanned readmission, as measured by the C statistic, was 0.88. CONCLUSIONS AND RELEVANCE: Patients undergoing total laryngectomy are an at-risk patient population with a high rate of unplanned readmission within 30 days of discharge. By identifying the risk factors that predict 30-day unplanned readmission, these data can be used to design and implement quality-improvement interventions to decrease readmissions.",
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N2 - IMPORTANCE: Patients undergoing total laryngectomy are at high risk for hospital readmission. Hospital readmissions are increasingly scrutinized because they are used as a metric of quality care and are subject to financial penalties. OBJECTIVE: To determine the rate of, reasons for, and risk factors that predict 30-day unplanned readmission for patients undergoing total laryngectomy. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study at a single academic tertiary referral medical center. The study population comprised 155 patients who underwent total laryngectomy with or without flap closure between January 2007 and December 2012 as either a primary treatment or salvage treatment for prior nonsurgical management. INTERVENTIONS: Total laryngectomy. MAIN OUTCOMES AND MEASURES: Rate of 30-day unplanned readmission, readmission diagnoses, and risk factors for unplanned readmission. Univariable and multivariable logistic regression were performed to identify risk factors for unplanned readmission within 30 days of discharge. RESULTS: The 30-day unplanned readmission rate for patients following discharge after total laryngectomy was 26.5%(41 of 155). The most common readmission diagnoses were pharyngocutaneous fistula (27%of readmissions; n = 11) and stomal cellulitis (16%of readmissions; n = 7). The median time to unplanned readmission was 7 days. Thirty-four percent of readmissions (14 of 41) occurred within 3 days of discharge. Significant predictors of 30-day unplanned readmission on multivariable analysis were postoperative complication after discharge (odds ratio [OR], 11.50; 95%CI, 4.10-32.28), visit to the emergency department within 30 days after discharge (OR, 5.25; 95%CI, 1.84-14.99), salvage total laryngectomy (OR, 3.52; 95%CI, 1.56-13.12), and chyle fistula during the index hospitalization (OR, 5.25; 95%CI, 0.86-29.92). The discriminative ability of the model to predict unplanned readmission, as measured by the C statistic, was 0.88. CONCLUSIONS AND RELEVANCE: Patients undergoing total laryngectomy are an at-risk patient population with a high rate of unplanned readmission within 30 days of discharge. By identifying the risk factors that predict 30-day unplanned readmission, these data can be used to design and implement quality-improvement interventions to decrease readmissions.

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