Post-Discharge Care Fragmentation Leads to Increased Risks for Patients with HN Cancer

What are the frequency, risk factors, and outcomes for patients with head and neck cancer experiencing post-discharge care fragmentation?

Bottom line
Post-discharge care fragmentation following head and neck cancer surgery is common, and head and neck cancer patients experiencing care fragmentation are at increased risk of in-hospital mortality within 30 days of readmission.

Background: For surgical patients, post-discharge care fragmentation refers to an unplanned readmission to a hospital other than the one at which the surgical procedure was performed. Postoperative care fragmentation has been reported in 25% of general surgery readmissions, and is associated with worse outcomes and an increased relative risk of mortality. Head and neck cancer patients in particular may be at risk for suboptimal outcomes.

Study design: Retrospective cohort study of 561 patients with a 30-day unplanned readmission following head and neck cancer surgery.

Setting: California State Inpatient Database (2008 to 2010) available through the Healthcare Cost and Utilization Project.

Synopsis: Of the 561 unplanned readmissions, 210 occurred at a non-index hospital. There was a statistically significant increased risk of readmission to a non-index hospital in patients with peripheral vascular disease, and a non-statistically significant trend for those with depression, renal failure, and weight loss, and for elderly patients.

Patients undergoing surgery at a medium-size hospital were 41% less likely to experience care fragmentation than patients whose surgery was at a large hospital. Patients with a longer index hospital length of stay were more likely to experience care fragmentation. Patients discharged from the index admission with home health or to a care facility had a higher risk of readmission to a non-index hospital compared to those discharged to home. Patients readmitted with a medical diagnosis were more than twice as likely to be readmitted to a non-index hospital as patients with a cancer diagnosis, and almost two times as likely as patients readmitted with a treatment complication.

Of the non-index group, the in-hospital mortality rate within 30-days of the unplanned readmission was 8.6%, a 2.1-fold increased risk.

Citation: Graboyes EM, Kallogjeri D, Saeed MJ, Olsen MA, Nussenbaum B. Postoperative care fragmentation and thirty-day unplanned readmissions after head and neck cancer surgery. Laryngoscope. 2017;127:868–874.