Predictors of returns to the emergency department after head and neck surgery

• Published in: Head & neck 2018-03, Vol.40 (3), p.498-511
• Main Authors: Baskin, R. Michael, Zhang, Jingnan, Dirain, Carolyn, Lipori, Paul, Fonseca, Gileno, Sawhney, Raja, Boyce, Brian J., Silver, Natalie L., Dziegielewski, Peter T.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cancer; Cohort Studies; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Female; Florida; Head and neck; Head and Neck Neoplasms - surgery; head and neck surgery; Health Care Costs - statistics & numerical data; Humans; Hypothyroidism; Male; Middle Aged; Morbidity; Patient admissions; Patient Readmission - economics; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; quality outcomes; readmissions; Retrospective Studies; return to the emergency department; return to the hospital; Risk Factors; Smoking; Surgery; Surgical Procedures, Operative - adverse effects; Young Adult
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.25019

Background Thirty‐day hospital readmissions have become a measure of quality of care. Many readmissions enter through the emergency department. The purposes of this study were to determine the rate, risk factors, and costs of 30‐day returns to the emergency department (30dEDRs) after head and neck surgery. Methods All adult patients undergoing head and neck surgery at the University of Florida from 2012 to 2014 were reviewed. Univariate and multivariate logistic regression analyses were performed to identify risk factors for 30dEDRs. Results We found 1065 patients who underwent 1173 procedures. There were 88 cases (7.5%) that resulted in 30dEDRs and 55 patients (4.7%) who had 30‐day unplanned readmissions (30dURs). Significant predictors of 30dEDRs included: smoking; hypothyroidism; and intensive care unit (ICU) stays. Significant predictors of readmission from an emergency department visit were Charlson Comorbidity Index (CCI) and cancer stage. Total costs of 30dEDRs and any subsequent readmissions topped $500 000. Conclusion The rate of 30dEDRs after head and neck surgery is low; however, these visits increase the hospitals' financial burden as well as patient morbidity. Predictors of 30dEDRs may be utilized to formulate preventative measures.