American College of Surgeons National Surgical Quality Improvement Program assessment of risk factors for 30-day unplanned readmission in patients undergoing head and neck surgery requiring free tissue reconstruction.

Abstract

Unplanned readmissions have become a metric for measuring quality of care. We analyzed the factors associated with 30-day unplanned readmission (30dUR) following head and neck cancer resections that included free tissue reconstruction (FTR). The 2012-2014 ACS-National Surgical Quality Improvement Program (NSQIP) data set was queried. Univariate and multivariate logistic regression analyses were performed. Out of 1114 cases, 121 had a 30dUR. The most common reasons were wound complications, including incisional infections, hematoma, and hemorrhage. A significant independent risk factor for 30dUR included a clean/contaminated wound class (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.20-4.76). Patients receiving an osseous FTR had lower readmission rates (OR, 0.51; CI, 0.27-0.91). Discharge destination had no statistical significance. Based on the NSQIP data set, 10.9% of patients receiving an FTR for head and neck malignancy had a 30dUR. Although large, population-based data sets have limitations, these results elucidate that these patients are at an increased risk for unplanned readmissions, which can guide patient expectations and discharge planning.