Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg. 2017 Dec 1;143(12):1200-1206. doi: 10.1001/jamaoto.2017.1460.
Patients undergoing total laryngectomy (TL) are at high risk for 30-day hospital readmission. Strategies to decrease the readmission rate remain unknown.
To assess the association of a comprehensive perioperative TL education program with unplanned readmissions; to determine the program’s association with the rate of readmissions for stomal or tracheoesophageal puncture (TEP) complications and patient and caregiver knowledge of and preparedness for TL.
DESIGN, SETTING, AND PARTICIPANTS: This single-institution prospective pilot study was conducted between December 1, 2014, and November 30, 2016, among 50 patients undergoing a perioperative TL education program at a tertiary care academic medical center.
The perioperative TL education program consisted of speech-language pathology counseling, a hands-on class with an otolaryngology nurse educator, a TL “Journal Guide” booklet, and a prehospital discharge competency assessment. A family member or friend acting as a laryngectomy coach accompanied patients throughout.
The primary outcome was the rate of 30-day unplanned readmission. Secondary measures included the rate of readmission for stomal or TEP complications and change in knowledge of and preparedness for TL.
Of the 50 patients (12 women and 38 men; median age, 61 years [range, 47-86 years]) who underwent the TL education program, the 30-day unplanned readmission rate was 20% (n=10). Only 1 patient (2%) had a readmission for a stomal or TEP complication. Patients increased their TL knowledge (median improvement in TL knowledge test score, 3.5 [95% CI, 2.8-4.2] of 12) and preparedness (median improvement in TL preparedness score, 3.1 [95% CI, 2.4-3.8] of 10) after undergoing the intervention.
This prospective pilot study evaluated an intervention to decrease unplanned readmission in head and neck oncology patients. It provides data indicating that a comprehensive perioperative TL education program is feasible. This program has the potential to decrease 30-day readmission for stomal or TEP complications and merits further study in a larger, multicenter clinical trial.
接受全喉切除术（TL）的患者有发生 30 天内再入院的高风险。降低再入院率的策略仍不清楚。
评估综合围手术期 TL 教育计划与非计划性再入院的关系；确定该计划与造口或气管食管穿刺（TEP）并发症再入院率的关系，以及患者和护理人员对 TL 的了解程度和准备情况。
设计、地点和参与者：这项单机构前瞻性试点研究于 2014 年 12 月 1 日至 2016 年 11 月 30 日在一家三级保健学术医疗中心进行，共纳入 50 例接受围手术期 TL 教育计划的患者。
围手术期 TL 教育计划包括语言病理学咨询、耳鼻喉科护士教育者的实践课程、TL“杂志指南”手册和医院前出院能力评估。一位作为喉切除术教练的家庭成员或朋友全程陪伴患者。
主要结局是 30 天内非计划性再入院率。次要措施包括造口或 TEP 并发症再入院率以及对 TL 的了解程度和准备情况的变化。
在接受 TL 教育计划的 50 例患者（12 例女性和 38 例男性；中位年龄 61 岁[范围，47-86 岁]）中，30 天内非计划性再入院率为 20%（n=10）。只有 1 例患者（2%）因造口或 TEP 并发症而再次入院。患者的 TL 知识（TL 知识测试评分中位数提高 3.5[95%CI，2.8-4.2]，满分 12 分）和准备情况（TL 准备评分中位数提高 3.1[95%CI，2.4-3.8]，满分 10 分）有所提高。
这项前瞻性试点研究评估了一项降低头颈部肿瘤患者非计划性再入院率的干预措施。它提供的数据表明，综合围手术期 TL 教育计划是可行的。该计划有可能降低 30 天内造口或 TEP 并发症的再入院率，值得在更大的多中心临床试验中进一步研究。
