Discharge Destination after Head and Neck Surgery: Predictors of Discharge to Postacute Care

John D. Cramer*, Urjeet A Patel, Sandeep Samant, Stephanie Shintani Smith

*Corresponding author for this work

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Objective In recent decades, there has been a reduction in the length of postoperative hospital stay, with a corresponding increase in discharge to postacute care. Discharge to postacute care facilities represents a meaningful patient-centered outcome; however, little has been published about this outcome after head and neck surgery. Study Design Retrospective review of national database. Setting American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013. Subjects and Methods We compared the rate of discharge to home versus postacute care facilities in patients admitted after head and neck surgery and used multivariable logistic regression to identify predictors of discharge to postacute care. Results The overall rate of discharge to postacute care facilities after head and neck surgery (n = 15,890) was 15.7% after major surgery (including laryngectomy, composite resection, and free tissue transfer), 4.4% after moderate surgery (including regional tissue transfer, oropharyngeal or oral cavity resection, and neck dissection), and 1.1% after minor head and neck surgery (including endocrine or salivary gland surgery). On multivariable analysis, significant preoperative predictors of discharge to postacute care were advanced age, functional status, major or moderate surgical procedures, tracheostomy, advanced American Society of Anesthesiologists class, low body mass index, and dyspnea. Conclusion Our study indicates that patients undergoing major or moderate head and neck surgery, patients with reduced functional status, and patients with advanced comorbidities are at substantial risk of discharge to postacute care. The possibility of discharge to postacute care should be discussed with high-risk patients.

Original languageEnglish (US)
Pages (from-to)997-1004
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume155
Issue number6
DOIs
StatePublished - Dec 1 2016

Fingerprint

Subacute Care
Neck
Head
Endocrine Glands
Laryngectomy
Neck Dissection
Tracheostomy
Quality Improvement
Salivary Glands
Dyspnea
Mouth
Comorbidity
Length of Stay
Body Mass Index
Retrospective Studies
Logistic Models
Databases

Keywords

  • discharge disposition
  • head and neck neoplasms
  • National Surgical Quality Improvement Program
  • postacute care
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

@article{157d835358234d7983c94585f5672253,
title = "Discharge Destination after Head and Neck Surgery: Predictors of Discharge to Postacute Care",
abstract = "Objective In recent decades, there has been a reduction in the length of postoperative hospital stay, with a corresponding increase in discharge to postacute care. Discharge to postacute care facilities represents a meaningful patient-centered outcome; however, little has been published about this outcome after head and neck surgery. Study Design Retrospective review of national database. Setting American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013. Subjects and Methods We compared the rate of discharge to home versus postacute care facilities in patients admitted after head and neck surgery and used multivariable logistic regression to identify predictors of discharge to postacute care. Results The overall rate of discharge to postacute care facilities after head and neck surgery (n = 15,890) was 15.7{\%} after major surgery (including laryngectomy, composite resection, and free tissue transfer), 4.4{\%} after moderate surgery (including regional tissue transfer, oropharyngeal or oral cavity resection, and neck dissection), and 1.1{\%} after minor head and neck surgery (including endocrine or salivary gland surgery). On multivariable analysis, significant preoperative predictors of discharge to postacute care were advanced age, functional status, major or moderate surgical procedures, tracheostomy, advanced American Society of Anesthesiologists class, low body mass index, and dyspnea. Conclusion Our study indicates that patients undergoing major or moderate head and neck surgery, patients with reduced functional status, and patients with advanced comorbidities are at substantial risk of discharge to postacute care. The possibility of discharge to postacute care should be discussed with high-risk patients.",
keywords = "discharge disposition, head and neck neoplasms, National Surgical Quality Improvement Program, postacute care, surgery",
author = "Cramer, {John D.} and Patel, {Urjeet A} and Sandeep Samant and Smith, {Stephanie Shintani}",
year = "2016",
month = "12",
day = "1",
doi = "10.1177/0194599816661514",
language = "English (US)",
volume = "155",
pages = "997--1004",
journal = "Otolaryngology - Head and Neck Surgery",
issn = "0194-5998",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Discharge Destination after Head and Neck Surgery

T2 - Predictors of Discharge to Postacute Care

AU - Cramer, John D.

AU - Patel, Urjeet A

AU - Samant, Sandeep

AU - Smith, Stephanie Shintani

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Objective In recent decades, there has been a reduction in the length of postoperative hospital stay, with a corresponding increase in discharge to postacute care. Discharge to postacute care facilities represents a meaningful patient-centered outcome; however, little has been published about this outcome after head and neck surgery. Study Design Retrospective review of national database. Setting American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013. Subjects and Methods We compared the rate of discharge to home versus postacute care facilities in patients admitted after head and neck surgery and used multivariable logistic regression to identify predictors of discharge to postacute care. Results The overall rate of discharge to postacute care facilities after head and neck surgery (n = 15,890) was 15.7% after major surgery (including laryngectomy, composite resection, and free tissue transfer), 4.4% after moderate surgery (including regional tissue transfer, oropharyngeal or oral cavity resection, and neck dissection), and 1.1% after minor head and neck surgery (including endocrine or salivary gland surgery). On multivariable analysis, significant preoperative predictors of discharge to postacute care were advanced age, functional status, major or moderate surgical procedures, tracheostomy, advanced American Society of Anesthesiologists class, low body mass index, and dyspnea. Conclusion Our study indicates that patients undergoing major or moderate head and neck surgery, patients with reduced functional status, and patients with advanced comorbidities are at substantial risk of discharge to postacute care. The possibility of discharge to postacute care should be discussed with high-risk patients.

AB - Objective In recent decades, there has been a reduction in the length of postoperative hospital stay, with a corresponding increase in discharge to postacute care. Discharge to postacute care facilities represents a meaningful patient-centered outcome; however, little has been published about this outcome after head and neck surgery. Study Design Retrospective review of national database. Setting American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013. Subjects and Methods We compared the rate of discharge to home versus postacute care facilities in patients admitted after head and neck surgery and used multivariable logistic regression to identify predictors of discharge to postacute care. Results The overall rate of discharge to postacute care facilities after head and neck surgery (n = 15,890) was 15.7% after major surgery (including laryngectomy, composite resection, and free tissue transfer), 4.4% after moderate surgery (including regional tissue transfer, oropharyngeal or oral cavity resection, and neck dissection), and 1.1% after minor head and neck surgery (including endocrine or salivary gland surgery). On multivariable analysis, significant preoperative predictors of discharge to postacute care were advanced age, functional status, major or moderate surgical procedures, tracheostomy, advanced American Society of Anesthesiologists class, low body mass index, and dyspnea. Conclusion Our study indicates that patients undergoing major or moderate head and neck surgery, patients with reduced functional status, and patients with advanced comorbidities are at substantial risk of discharge to postacute care. The possibility of discharge to postacute care should be discussed with high-risk patients.

KW - discharge disposition

KW - head and neck neoplasms

KW - National Surgical Quality Improvement Program

KW - postacute care

KW - surgery

UR - http://www.scopus.com/inward/record.url?scp=85002486917&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85002486917&partnerID=8YFLogxK

U2 - 10.1177/0194599816661514

DO - 10.1177/0194599816661514

M3 - Review article

C2 - 27484235

AN - SCOPUS:85002486917

VL - 155

SP - 997

EP - 1004

JO - Otolaryngology - Head and Neck Surgery

JF - Otolaryngology - Head and Neck Surgery

SN - 0194-5998

IS - 6

ER -