Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer. (March 2019)

• Record Type: Journal Article
• Authors: Badr, Hoda; Sobrero, Maximiliano; Chen, Joshua; Kotz, Tamar; Genden, Eric; Sikora, Andrew G.; Miles, Brett
• Is Part Of: Oral oncology. Volume 90(2019)
• Page Start: 102
• Page End: 108
• Publication Date: 2019-03
• Subjects: Quality of life -- Health resource use -- Head and neck cancer -- Surgery -- M D Anderson Dysphagia Inventory; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2019.02.004
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Pre-, post-, and peri-operative variables predicting health resource use were examined . Pre-surgical QOL significantly predicted length of stay (LOS). Pre-surgical dysphagia predicted LOS, readmissions, and emergency room visits. Pre-surgical dysphagia and QOL assessment may help identify at-risk patients. Abstract: Objective: We examined associations between pre-, post-, and peri-operative variables and health resource use in head and neck cancer patients. Methods: Patients (N = 183) who were seen for a pre-surgical consult between January 2012 and December 2014 completed surveys that assessed medical history, a patient-reported outcome measure (PROM) of dysphagia, and quality of life (QOL). After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative (e.g., complications) variables were abstracted from patients' medical records. Results: Multivariate regression models using backward elimination showed that pre-surgical University of Washington Quality of Life (UW-QOL) Inventory and M.D. Anderson Dysphagia Inventory (MDADI) composite scores, documented surgical complications, and having a tracheostomy, were all significant predictors of hospital length of stay, explaining 57% of the total variance (F(5, 160) = 18.71, p < .001). Male gender, psychiatric history, and lower pre-surgical MDADI scores significantly predicted thirty-day unplanned readmissions (30dUR). Pre-surgical MDADI composite scores also significantly predicted emergencey department (ED) visits within 30 days of initial hospital discharge (p = .02). Conclusions: Assessment of PROMs and QOL in the pre-surgical setting may assist providers in identifying patients at risk for prolonged LOS and increased health resource use after hospital discharge.