Background: Patients undergoing a total laryngectomy require multi-domain complex care and support during their post-surgical recovery in the hospital and subsequently, following discharge from the hospital. Identification of differences in outcomes for patients discharged to intermediate care facilities versus home-based setting can help determine if incidence of peri-operative adverse events is associated with the post-discharge care environment.
Objective: To evaluate differences in 30-day perioperative outcomes of patients discharged to intermediate care facility versus their home following total laryngectomy.
Methods: Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP) database to identify discharge patterns for total laryngectomy patients (n=492) between 2011 and 2014. Univariate analyses were performed to identify differences in post-discharge 30-day outcomes between groups stratified by discharge destination (intermediate care facility versus home).
Differences in incidence of 30-day readmission, reoperation, medical and surgical complications were assessed. Analyses were performed using either exact Pearson chi-square tests, exact Mantel-Haenszel chi-square tests, Fisher’s exact tests, or t-tests, as appropriate.
Results: Four hundred and one patients (81.5%) were discharged to home and 86 others (17.5%) were discharged to intermediate care facilities. Data related to 30-day readmission was available for 382 patients. Patients who were discharged to intermediate care facilities had baseline disadvantages including advanced age, poor functional status, antecedent heart failure, and chronic steroid use; a higher incidence of post-operative pneumonia and sepsis; and a longer hospital course.
Despite these challenges, the incidence of 30-day readmission was similar for patients discharged to intermediate care facilities (17%) and those discharged to home (12%), p=0.348. The incidence of 30-day reoperation remained low in both groups (6% versus 5%, p=1.000). There were no differences between patient groups in terms of incidence of post-discharge surgical site infection, cardiopulmonary complications, venous thromboembolism or sepsis (all p>0.05).
Conclusion and clinical significance: Following a total laryngectomy, the incidence of post discharge adverse events (readmission, reoperation, medical and surgical complications) is similar between patients who were discharged to an intermediate care facility and those who were dismissed to their home.
Although patients dismissed to intermediate care facilities had higher incidence of baseline comorbidities, the comparable outcomes between the two groups may suggest positive impact of skilled care on post-discharge convalescence following a total laryngectomy.
These findings may inform clinician and patient perceptions about health care delivered at intermediate care facilities when discharge to a facility other than home is medically indicated.