Cramer John D, Patel Urjeet A, Samant Sandeep, Shintani Smith Stephanie
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Otolaryngol Head Neck Surg. 2016 Dec;155(6):997-1004. doi: 10.1177/0194599816661514. Epub 2016 Aug 2.
In recent decades, there has been a reduction in the length of postoperative hospital stay, with a corresponding increase in discharge to postacute care. Discharge to postacute care facilities represents a meaningful patient-centered outcome; however, little has been published about this outcome after head and neck surgery.
Retrospective review of national database.
American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013.
We compared the rate of discharge to home versus postacute care facilities in patients admitted after head and neck surgery and used multivariable logistic regression to identify predictors of discharge to postacute care.
The overall rate of discharge to postacute care facilities after head and neck surgery (n = 15,890) was 15.7% after major surgery (including laryngectomy, composite resection, and free tissue transfer), 4.4% after moderate surgery (including regional tissue transfer, oropharyngeal or oral cavity resection, and neck dissection), and 1.1% after minor head and neck surgery (including endocrine or salivary gland surgery). On multivariable analysis, significant preoperative predictors of discharge to postacute care were advanced age, functional status, major or moderate surgical procedures, tracheostomy, advanced American Society of Anesthesiologists class, low body mass index, and dyspnea.
Our study indicates that patients undergoing major or moderate head and neck surgery, patients with reduced functional status, and patients with advanced comorbidities are at substantial risk of discharge to postacute care. The possibility of discharge to postacute care should be discussed with high-risk patients.
近几十年来，术后住院时间有所缩短，相应地，转至急性后期护理机构的出院人数有所增加。转至急性后期护理机构是一项以患者为中心的重要结果；然而，关于头颈外科手术后这一结果的报道却很少。
对国家数据库进行回顾性分析。
2011年至2013年美国外科医师学会国家外科质量改进计划。
我们比较了头颈外科手术后入院患者回家与转至急性后期护理机构的出院率，并使用多变量逻辑回归分析来确定转至急性后期护理机构的预测因素。
头颈外科手术后（n = 15,890），大手术（包括喉切除术、联合切除术和游离组织移植）后转至急性后期护理机构的总体出院率为15.7%，中等手术（包括区域组织移植、口咽或口腔切除术以及颈部清扫术）后为4.4%，小头颈手术（包括内分泌或唾液腺手术）后为1.1%。多变量分析显示，术前转至急性后期护理机构的显著预测因素包括高龄、功能状态、大手术或中等手术、气管切开术、美国麻醉医师协会分级较高、低体重指数和呼吸困难。
我们的研究表明，接受大手术或中等手术的头颈外科患者、功能状态较差的患者以及合并症严重的患者转至急性后期护理机构的风险很大。应与高危患者讨论转至急性后期护理机构的可能性。
