Shenson Jared A, Craig Jennifer N, Rohde Sarah L
1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Otolaryngol Head Neck Surg. 2017 Feb;156(2):289-298. doi: 10.1177/0194599816671695. Epub 2016 Oct 3.
Objective Total laryngectomy (TL) is a high-cost procedure with patients at risk for significant postoperative health care use. Face-to-face preoperative counseling provided by speech-language pathologists is a relatively inexpensive intervention that may improve care quality and decrease costs. We evaluated if preoperative counseling for patients undergoing TL was associated with differences in length of stay (LOS), use of the emergency department (ED), or unplanned readmissions within 30 days of discharge. A secondary analysis identified predictors of these 3 outcomes. Study Design Case series with chart review. Setting Academic medical center in the United States. Subjects and Methods Patients were included if they underwent TL from 2011 to 2015. Patient demographics and comorbidities, surgical characteristics, and perioperative care data were retrieved and analyzed for 116 patients. Univariate and multivariate models were constructed for 3 outcomes. Results LOS was significantly lower for patients receiving counseling (-3.0 days, P = .02). No differences were observed in rates of 30-day ED visits or unplanned readmissions. Care provided by high-volume surgeons was associated with decreased LOS ( P = .005), while having postoperative complications increased LOS ( P < .001). High rates of ED visits (12.1%) and readmissions (20.6%) were observed. Discharge to inpatient rehabilitation and the patient's home distance from the institution were predictors of ED visits. TL as salvage therapy and occurrence of postoperative complications were risk factors for readmission. Conclusion Preoperative counseling was associated with marked reduction in LOS following TL without increased readmissions, which suggests that it may promote safe, earlier patient readiness for discharge.
目的 全喉切除术（TL）是一种高成本的手术，患者术后有大量使用医疗保健服务的风险。言语病理学家提供的面对面术前咨询是一种相对低成本的干预措施，可能会提高护理质量并降低成本。我们评估了接受TL手术患者的术前咨询是否与住院时间（LOS）、急诊科（ED）使用情况或出院后30天内的非计划再入院差异有关。二次分析确定了这三个结果的预测因素。研究设计 带有图表回顾的病例系列。地点 美国的学术医疗中心。对象和方法 纳入2011年至2015年接受TL手术的患者。检索并分析了116例患者的人口统计学和合并症、手术特征以及围手术期护理数据。针对三个结果构建了单变量和多变量模型。结果 接受咨询的患者住院时间显著缩短（-3.0天，P = 0.02）。30天内急诊科就诊率或非计划再入院率未观察到差异。高手术量外科医生提供的护理与住院时间缩短相关（P = 0.005），而术后出现并发症会增加住院时间（P < 0.001）。观察到较高的急诊科就诊率（12.1%）和再入院率（20.6%）。出院到住院康复机构以及患者住所与机构的距离是急诊科就诊的预测因素。TL作为挽救性治疗和术后并发症的发生是再入院的危险因素。结论 术前咨询与TL术后住院时间显著缩短相关，且未增加再入院率，这表明它可能促进患者安全、更早地准备出院。
