Analysis of readmissions after transoral robotic surgery for oropharyngeal squamous cell carcinoma

• Published in: Head & neck 2018-11, Vol.40 (11), p.2416-2423
• Main Authors: Parhar, Harman S., Gausden, Elizabeth, Patel, Jayendrakumar, Prisman, Eitan, Anderson, Donald W., Durham, J. Scott, Rush, Barret
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Cohort Studies; Databases, Factual; Diet; Disease-Free Survival; Female; Head and neck; Hemorrhage; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Natural Orifice Endoscopic Surgery - adverse effects; Natural Orifice Endoscopic Surgery - methods; Neoplasm Invasiveness - pathology; Neoplasm Staging; oropharyngeal cancer; Oropharyngeal Neoplasms - mortality; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - surgery; Ostomy; Patient Readmission - statistics & numerical data; patient safety; Pneumonia; Postoperative Complications - mortality; Postoperative Complications - pathology; Postoperative Complications - therapy; Predictive Value of Tests; Prognosis; Quality control; quality improvement; readmission; Retrospective Studies; Risk Assessment; Robotic surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Squamous cell carcinoma; Survival Analysis; Throat cancer; Tracheostomy; transoral robotic surgery; United States
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.25362

Background As transoral robotic surgery (TORS) is being increasingly used to treat patients with oropharyngeal squamous cell carcinoma (OPSCC), there is an interest in determining contributors to readmission. Methods We conducted this retrospective multivariate analysis modeling 30‐day readmission using the Nationwide Readmissions Database (2012–2014). Results Of 950 patients, 117 (12.3%) were readmitted. Hemorrhage and diet/aspiration accounted for 32.5% and 19.7% of readmissions, respectively. Of those readmitted, 23.1% required operative bleeding control, 11.1% required transfusion, 1.7% required tracheostomy, and 18.8% required gastrostomies. Those readmitted were older (mean 63.2 years, SD 9.5 vs 60.9 mean years, SD 10.3) and had longer hospitalizations (mean 5.7 days, SD 6.8 vs mean 4.3 days, SD 4.1) and higher rates of aspiration/pneumonia (9.4% vs 2.4%, P < .01) on index admission. Multivariate analysis demonstrated that aspiration/pneumonia on index admission was independently associated with readmission (OR 3.128, 95% CI 1.178‐8.302). Conclusions Of the patients 12.3% were readmitted within 30 days with hemorrhage and diet complications as significant contributors.