Identifying Metrics before and after Readmission following Head and Neck Surgery and Factors Affecting Readmission Rate

Objectives. Determine nationally representative readmission rates after head and neck cancer (HNCA) surgery and factors associated with readmission. Study Design. Cross-sectional analysis of admissions database. Methods. The 2013 Nationwide Readmissions Database was analyzed for HNCA surgery admissions and subsequent readmission within 30 days. The readmission rate, length of stay (LOS), disposition, mortality rate, and total charges were determined. Diagnoses and procedures upon readmission were quantified. Factors that were associated with readmission were determined. Results. In total, 132,755 HNCA surgery inpatient admissions (mean age, 57.3 years; 52.2% male) were analyzed. Nationally representative metrics for HNCA surgery were mean LOS (4.4 0.1 days), disposition (home without services, 80.5%; home health care, 10.9%; and skilled facility, 6.6%), mortality rate (1.0% +/- 0.1%), and total charges ($53,106 +/- $1167). The readmission rate was 7.7% +/- 0.2% (mean readmission postoperative days, 17.1 +/- 0.1), with readmission LOS (5.6 +/- 0.1 days), mortality rate (3.7% +/- 0.3%), and total charges ($49,425 +/- $1548). The most common diagnoses at readmission included surgical complications (15.5%), mental health and substance abuse (13.1%), hypertension (12.8%), septicemia/infection (12.1%), gastrointestinal disease (11.3%), nutritional/metabolic disorders (10.1%), electrolyte abnormalities (8.5%), and esophageal disorders (8.1%). In multivariate analyses, male sex, increasing All Patients Refined Diagnosis Related Group (APR-DRG) severity score, and initial LOS were associated with readmission (odds ratio [95% confidence interval], 1.11 [1.04-1.20], 1.94 [1.77-2.12], and 1.34 [1.22-1.48], respectively), whereas age and discharge location were not (P = .361 and .482). Conclusion. HNCA surgery readmission is associated with significant increases in services/skilled care on discharge, mortality, and additional total health care cost. This national analysis identifies common readmission diagnoses to target to prevent readmissions.