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Hospital-acquired conditions in head and neck cancer surgery

Amit Kochhar1, Peter J Pronovost, Christine G Gourin

  • 1Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA.

The Laryngoscope
|June 5, 2013
PubMed

Insights

Hospital-acquired conditions (HACs) are rare in head and neck cancer surgery. However, HACs significantly increase mortality, complications, and costs, necessitating universal prevention strategies.

Area of Science:

  • Oncology
  • Healthcare Management
  • Patient Safety

Background:

  • The Centers for Medicare and Medicaid Services penalize hospitals for 10 specific hospital-acquired conditions (HACs).
  • Head and neck cancer (HNCA) surgery patients may be at risk for HACs.
  • Understanding HAC incidence and impact in HNCA surgery is crucial for quality improvement.

Purpose of the Study:

  • To determine the incidence of HACs in patients undergoing head and neck cancer surgery.
  • To assess the association of HACs with in-hospital mortality, complications, length of hospitalization, and costs.

Main Methods:

  • Retrospective cross-sectional study using Nationwide Inpatient Sample data (2001-2008).
  • Analysis of 123,662 patients undergoing ablative procedures for malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasms.
  • Cross-tabulations and multivariate regression modeling were employed.

Main Results:

  • Hospital-acquired conditions (HACs) occurred in less than 1% of cases, with vascular catheter-associated infection being the most common (>70%).
  • HACs were significantly associated with urgent/emergent admission, major surgery, flap reconstruction, and advanced comorbidity.
  • HACs significantly increased in-hospital mortality, surgical and medical complications, length of hospitalization, and hospital costs.

Conclusions:

  • Hospital-acquired conditions (HACs) are infrequent in head and neck cancer surgery patients.
  • Poor predictability and the universal nature of human error underscore the need for innovative, widespread measures to reduce HACs.
  • Universal strategies are essential to mitigate HACs across diverse patient populations and healthcare settings.
Abstract

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