Prediction of Discharge Destination following Laryngectomy. (December 2018)

• Record Type: Journal Article
• Authors: Panwar, Aru; Wang, Fangfang; Lindau, Robert; Militsakh, Oleg; Coughlin, Andrew; Smith, Russell; Sayles, Harlan; Lydiatt, Daniel; Lydiatt, William
• Is Part Of: Otolaryngology--head and neck surgery. Volume 159:Number 6(2018)
• Page Start: 1006
• Page End: 1011
• Publication Date: 2018-12
• Subjects: laryngectomy -- discharge destination -- disposition -- prediction -- discharge planning; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599818792211
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To identify factors that may predict discharge to intermediate-care facilities following total laryngectomy and may promote earlier discharge planning and optimize resource utilization. Study Design: Retrospective review of large national data set. Setting: Academic and nonacademic health care facilities in United States, contributing deidentified, risk-adjusted clinical data to the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP). Subjects and Methods: Retrospective evaluation of the NSQIP database (2011-2014) identified 487 patients who underwent total laryngectomy without free tissue transfer. Risk of discharge to intermediate-care facilities was evaluated. Role of preoperative and postoperative factors and their association with discharge disposition were assessed using multivariable regression analysis. Results: Compared to reference groups, advanced age (61-70 years: odds ratio [OR], 3.16; 95% confidence interval [CI], 1.12-8.89; >70 years: OR, 3.77; 95% CI, 1.33-10.65), baseline functional dependence (OR, 5.61; 95% CI, 2.62-12.02), cardiac failure (OR, 3.80; 95% CI, 1.08-13.42), and steroid dependence (OR, 3.30; 95% CI, 1.36-8.0) independently predicted discharge to intermediate-care facilities. Conclusion: Patients with advanced age, functional dependence, cardiac failure, and steroid dependence may benefit from preemptive counseling and discharge planning in anticipation of postlaryngectomy discharge to intermediate-care facilities.