Journal
MICROSURGERY
Volume 37, Issue 6, Pages 502-508Publisher
WILEY
DOI: 10.1002/micr.30116
Keywords
unplanned readmissions; NSQIP; head and neck reconstruction; free flap; microsurgery
Categories
Funding
- Biostatistics program in the Department of Surgery at the University of Wisconsin
- Wisconsin Surgical Outcomes Research Program (WiSOR)
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IntroductionUnplanned readmissions are associated with decreased healthcare quality and increased costs. This nationwide study examines causes for unplanned readmission among head and neck cancer patients undergoing immediate microsurgical reconstruction. MethodsPatients undergoing head and neck tumor resection with microsurgical reconstruction were identified in the 2011-2014 National Surgical Quality Improvement Program database. Clinical characteristics and complications were compared among patients who did and did not undergo unplanned readmission. Univariate and multivariate logistic regression analyses were performed. ResultsDatabase search revealed 1,063 patients, 94 (8.8%) of whom had unplanned readmissions. Readmitted patients had significantly higher ASA scores (14.9% vs.7.3% ASA class 4 patients; P=0.03) and significantly higher rates of disseminated cancer (14.9% vs.7.1%; P=0.01), laryngopharyngectomy (17.0% vs.6.9%; P=0.0005), deep wound infection (22.3% vs.2.4%; P<0.0001), wound dehiscence (19.1% vs.3.3%; P < 0.0001), and blood transfusion within 72 h of surgery (44.7% vs.32.6%; P=0.02). Multivariate logistic regression revealed deep wound infection (OR=8.65, P<0.0001) and wound dehiscence (OR=3.69, P=0.0004) to be independent predictors of unplanned readmission. ConclusionsDeep wound infection and wound dehiscence were independent predictors of unplanned readmission among head and neck cancer patients undergoing immediate microsurgical reconstruction. Institutions should focus efforts on improving wound surveillance, outpatient strategies for wound care, and optimization of discharge planning for this complex patient population.
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