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

Head Neck. 2018 Nov;40(11):2416-2423. doi: 10.1002/hed.25362. Epub 2018 Aug 13.

Abstract

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.

Keywords: oropharyngeal cancer; patient safety; quality improvement; readmission; transoral robotic surgery.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery*
  • Cohort Studies
  • Databases, Factual
  • Disease-Free Survival
  • Female
  • 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 Neoplasms / mortality
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / surgery*
  • Patient Readmission / statistics & numerical data*
  • Postoperative Complications / mortality
  • Postoperative Complications / pathology
  • Postoperative Complications / therapy
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Robotic Surgical Procedures / adverse effects*
  • Robotic Surgical Procedures / methods
  • Survival Analysis
  • United States