Discharge Destination after Head and Neck Surgery: Predictors of Discharge to Postacute Care. (December 2016) - Cramer, John D.
Objective: In recent decades, there has been a reduction in the length of postoperative hospital stay, with a corresponding increase in discharge to postacute care. Discharge to postacute care facilities represents a meaningful patient-centered outcome; however, little has been published about this outcome after head and neck surgery. Study Design: Retrospective review of national database. Setting: American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013. Subjects and Methods: We compared the rate of discharge to home versus postacute care facilities in patients admitted after head and neck surgery and used multivariable logistic regression to identify predictors of discharge to postacute care. Results: The overall rate of discharge to postacute care facilities after head and neck surgery (n = 15, 890) was 15.7% after major surgery (including laryngectomy, composite resection, and free tissue transfer), 4.4% after moderate surgery (including regional tissue transfer, oropharyngeal or oral cavity resection, and neck dissection), and 1.1% after minor head and neck surgery (including endocrine or salivary gland surgery). On multivariable analysis, significant preoperative predictors of discharge to postacute care were advanced age, functional status, major or moderate surgical procedures, tracheostomy, advanced American Society of Anesthesiologists class, low body mass index, and dyspnea. Conclusion: Our study indicates that patients undergoing major or moderate head and neck surgery, patients with reduced functional status, and patients with advanced comorbidities are at substantial risk of discharge to postacute care. The possibility of discharge to postacute care should be discussed with high-risk patients.