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Readmission Rates Following Major Head and Neck Surgery With Concurrent Tracheostomy
Philip R Brauer1,2, Paul C Bryson1,2,3, William S Tierney2
1School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Insights
Major head and neck surgery with tracheostomy has high complication rates, but readmission risk is not increased by the underlying procedure. Surgeons can be reassured that tracheostomies do not disproportionately raise readmission risks when managed properly.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Critical Care Medicine
Background:
- Tracheostomy is frequently performed in conjunction with major head and neck surgeries.
- Understanding the impact of the primary surgical procedure on tracheostomy outcomes is crucial for patient management and resource allocation.
Purpose of the Study:
- To investigate the influence of various major head and neck procedures on readmission and complication rates following tracheostomy.
Main Methods:
- A retrospective cohort study utilized the 2005-2017 National Surgical Quality Improvement Program (NSQIP) database.
- Current Procedural Terminology (CPT) codes identified tracheostomy patients and defined underlying head and neck procedures.
- Univariate and multivariable analyses were conducted, excluding patients under 18 or with unknown pre-operative variables.
Main Results:
- Of 3240 patients, 9.0% were readmitted within 30 days, and 19.7% had an unplanned return to the operating room.
- Nearly half (49.6%) experienced non-tracheostomy specific complications (26.2% medical, 35.2% surgical).
- Underlying procedures did not significantly impact readmission risk; only thyroidectomies showed a lower risk for unplanned return to OR compared to free tissue graft reconstruction.
Conclusions:
- Major head and neck surgery with tracheostomy is associated with a high overall complication rate.
- Readmission rates following tracheostomy are not significantly influenced by the type of underlying head and neck procedure.
- These findings suggest that properly managed tracheostomies in the context of major head and neck surgery do not pose a disproportionate readmission risk.
Objectives:
To determine the influence of major head and neck procedures on readmission and complication rates following tracheostomy.
Methods:
A retrospective cohort study using the 2005 to 2017 National Surgical Quality Improvement Program (NSQIP) database. Current Procedural Terminology codes were used to identify tracheostomy patients and to define the underlying head and neck procedure. Patients under the age of 18 and with unknown pre-operative variables were excluded. Univariate and multivariable analyses were performed.
Results:
A total of 3240 tracheostomy patients undergoing major head and neck surgery were identified in NSQIP. The 30-day mortality rate was 104 (3.2%) and 258 (9.0%) patients were readmitted. 637 (19.7%) patients had an unplanned return to the operating room. There were 1606 (49.6%) non-tracheostomy specific complications, which included 850 (26.2%) medical and 1142 (35.2%) surgical complications. On multivariable analysis, we found that the underlying procedures did not impact the risk of readmission (P > .05 for all). The underlying procedure was also not associated with unplanned return to the operating room except for thyroidectomies, which had a lower risk than free tissue graft reconstruction (OR = 0.53 (95%CI 0.31, 0.88), P = .018).
Conclusion:
While almost 1 in every 2 patients had a complication following major head and neck surgery that included creation of a tracheostomy, the rate of readmission is comparatively low and is not associated with the underlying procedure. These findings should reassure head and neck surgeons that properly managed tracheostomies do not constitute a disproportionate risk of readmission.
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