Prevalence and Patient-Level Risk Factors for 30-Day Readmissions Following Free Tissue Transfer for Head and Neck Cancer.

IMPORTANCE

Hospital readmissions are a marker of surgical care delivery and quality that are progressively more scrutinized.

OBJECTIVE

To provide a comprehensive analysis of 30-day readmissions for patients with head and neck cancer who underwent free flap reconstruction to highlight the rate, causes, and associated patient risk factors.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at a single tertiary care academic institution. The study consisted of 249 patients who underwent microvascular reconstruction of a presumed head and neck oncologic defect from January 1, 2000, through June 30, 2014. Follow-up continued through July 30, 2014.

INTERVENTIONS

Microvascular reconstruction of an oncologic head and neck defect.

MAIN OUTCOMES AND MEASURES

Incidence of 30-day all-cause readmissions, patient risk factors, and readmission indications. Regression analyses were conducted to discern patient-level risk factors related to 30-day readmissions.

RESULTS

Among the 249 patients, the 30-day all-cause readmission rate was 14.5%, while the unplanned readmission rate was 11.6%. The most common reason for readmission was neck wound complications. Predictors of readmission following multivariable analysis were T4 pathologic stage (odds ratio [OR], 11.68; 95% CI, 1.37-99.81; P = .02) and having a tumor located in the oropharynx (OR, 4.64; 95% CI, 1.89-11.38; P = .001), hypopharynx (OR, 8.30; 95% CI, 1.52-45.24; P = .01), or larynx (OR, 10.97; 95% CI, 2.27-52.98; P = .003). Patients who were readmitted were more likely to experience neck wound complications (OR, 5.07; 95% CI, 1.31-19.57; P = .02) and undergo reoperation (OR, 47.20; 95% CI, 8.33-267.33; P < .001).

CONCLUSIONS AND RELEVANCE

In this study, advanced pathologic tumor staging and tumor location were associated with 30-day readmissions in patients with head and neck cancer who receive free flaps. Our results provide a benchmark for risk stratification that can be used in system-based practice improvements, health care cost savings, and postoperative patient counseling.