Postdischarge complications predict reoperation and mortality after otolaryngologic surgery

Area of Science:

• Otolaryngology
• Surgical Outcomes
• Patient Safety

Background:

• Postdischarge complications (PDCs) following inpatient otolaryngologic surgery represent a significant concern for patient outcomes.
• Understanding the incidence, timing, and risk factors of PDCs is crucial for improving surgical care.

Purpose of the Study:

• To determine procedure-specific rates of PDCs within 30 days of otolaryngologic surgery.
• To identify risk factors associated with PDCs.
• To evaluate the association between PDCs and the risks of reoperation and mortality.

Main Methods:

• A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2011).
• 48,028 adult patients undergoing inpatient otolaryngologic surgery were analyzed.
• Statistical analyses included chi-square tests, t-tests, and multivariate regression to assess outcomes, including complications, reoperation, and mortality.

Main Results:

• Laryngectomy, lip, and tongue/floor of mouth surgeries exhibited the highest PDC rates (8.0%, 7.4%, 4.1%).
• A significant proportion of PDCs occurred within the first 48 hours (10%), first week (44%), and first two weeks (73%) post-discharge.
• Independent risk factors for PDCs included increasing age, prolonged operative time, longer hospital stay, and higher American Society of Anesthesiologists (ASA) class (≥ 3).
• PDCs were significantly associated with increased mortality (0.9% vs 0.1%) and reoperation rates (10.4% vs 1.2%).

Conclusions:

• This study highlights that postdischarge complications in otolaryngology are frequent, occur early, and vary by surgical procedure.
• PDCs are significantly linked to increased risks of reoperation and mortality.
• Implementing targeted, procedure-specific triage and follow-up strategies for high-risk patients is recommended to enhance patient outcomes.