Importance: With a dramatic increase in the incidence of human papilloma virus (HPV) related oropharyngeal carcinoma (OPSCC), there has been a significant interest in the use of minimally invasive surgical techniques, such as transoral robotic surgery (TORS), to avoid the long-term morbidity conferred by traditional surgical approaches and radiotherapy. With this evolving new technology, there is a need to study the patterns and predictors of readmission.
Objective: To estimate the 60-day all-cause cumulative readmission rate in a nationwide sample and identify predictors of readmission.
Design: Retrospective linked nationwide analysis (2012–2014) for all hospital readmissions using the federal all-payer Nationwide Readmission Database (NRD).
Setting: All hospitalizations from 22 participating states representing 51% of the US population and 49% of all in-patient hospital stays.
Participants: Patients >18 years of age who underwent TORS for OPSCC.
Exposures: The following patient-level covariates were examined: age, sex, comorbid status, insurance coverage, income and discharge disposition. The effects of concurrent procedures were also examined including tracheostomy, gastrostomy, flap/graft and neck dissection. Additionally, postoperative complications including hemorrhage, prolonged ventilation, aspiration/pneumonia and wound complications were examined.
Outcomes: 60 days readmission rate and diagnosis on readmission.
Results: 955 patients underwent TORS and 950 (99.5%) survived index admission. After excluding those readmitted for staged neck dissection, 174 (18.3%) were readmitted for complications. Hemorrhage accounted for 23.6% of readmissions and 18.4% of patients returned with diet/aspiration related complications. Of those readmitted, 16.1% required operative control of bleeding, 10.3% required transfusion, 4.0% required tracheostomy, and 18.4% required gastrostomies. Those readmitted had higher rates of index hemorrhage (8.6% vs 4.1%, p=0.01), aspiration/pneumonia (8.1% vs 4.4%, p=0.02) and wound complications (10.3% vs 5.5%, p=0.02). After multivariate analysis, factors associated with readmission were high number of medical comorbidities (OR 4.033, 95% CI 1.567-10.377) and discharge to Home Care (OR 1.661, 95% CI 1.032-2.675) as well as Skilled Nursing Facilities (OR 2.042, 95% CI 1.275-6.790).
Conclusions: 18.3% of patients undergoing TORS for OPSCC were readmitted within 60-days of discharge and 32.8% of readmissions occurred between 30 and 60-days. Postoperative hemorrhage (23.6%) and diet related complications (18.4%) were significant contributors to readmission.