Presentation: S040
Topic: Value and Quality in H&N Surgery (Value-Based Care)
Type: Oral
Date: Thursday, April 27, 2017
Session: 1:00 PM - 2:00 PM Value-Based H&N Cancer Care
Authors: Michelle M Chen, MD, Ryan K Orosco, MD, Jeremy P Harris, MD, Julie B Porter, MS, Eben L Rosenthal, MD, Wendy Hara, MD, Vasu Divi, MD
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Institution(s): Stanford University
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Importance: The Hospital Readmissions Reduction Program levies a financial penalty on hospitals with readmissions in excess of the national rate. There are concerns from providers on the validity of these metrics and the degree of risk-adjustment for patient factors that may influence the likelihood of readmission. Oncology patients in particular often have multiple comorbidities and are at high risk of readmission.

Objective: To evaluate the cause of and risk factors for readmission for head and neck cancer patients.

Design: Retrospective cohort study

Setting: Nationwide Readmissions Database (January 1, 2013 to December 31, 2013)

Participants: Adult patients who had surgery for head and neck cancer.

Main Outcomes and Measures: Our main outcome was 30-day readmission. Statistical analysis included 2-sided t tests, χ2, and multivariate logistic regression analysis.

Results: We identified a nationally weighted total of 11,832 patients who were assessed for 30-day readmissions. Within 30 days, 16.1% of patients were readmitted and 20% of readmissions were not at the index hospital.  The total cost of these readmissions was $31 million. Readmission rates varied by tumor site, with hypopharyngeal cancer having the highest readmission rate (29.6%), followed by laryngeal (21.8%), oropharyngeal (18.2%), and oral cavity (11.6%) cancers (P< .001). Over half of all 30-day readmissions occurred within the first 10 days after discharge. 24.8% of all readmitted patients had an infectious diagnosis. Patient insurance was not associated with readmission; however, patients from areas with lower household incomes were more likely to be readmitted (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.16-2.05). Of 21 patient comorbidities examined, patients with valvular disease (OR, 2.07; 95% CI, 1.16-3.69), rheumatoid arthritis or collagen vascular disease (OR, 2.05; 95% CI, 1.27-3.31), liver disease (OR, 2.02, 95% CI, 1.37-2.99), and hypothyroidism (OR 1.30; 95% CI, 1.02-1.66) were at highest risk of readmission. Teaching hospital status was the only hospital level factor that was independently associated with increased risk of readmission (1.48; 95% CI, 1.02-2.13).

Conclusions and Relevance: Over half of readmissions after head and neck cancer surgery occur within ten days of hospital discharge. Readmissions after head and neck surgery are most commonly associated with an infectious diagnosis and vary significantly based on surgical site. Readmission reduction programs for head and neck cancer patients should be risk adjusted for tumor site, patient socioeconomic status, select comorbidities, and hospital type.

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