Feasibility of Early Discharge after Open Hypopharyngeal Surgery for Dysphagia. (September 2020)

• Record Type: Journal Article
• Authors: Patel, Jena; Spiegel, Joseph; Topf, Michael C.; Boon, Maurits; Huntley, Colin
• Is Part Of: Annals of otology, rhinology & laryngology. Volume 129:Number 9(2020)
• Page Start: 894
• Page End: 900
• Publication Date: 2020-09
• Subjects: Zenker's diverticulum -- cricopharyngeal myotomy -- complications -- early discharge -- readmission; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0003489420916216
• Languages: English
• ISSNs: 0003-4894

Abstract

Objective: To determine the rate of surgical complications, unplanned readmission, and functional status after open hypopharyngeal surgery for dysphagia with early return to oral diet and hospital discharge. Methods: Retrospective chart review of patients who underwent open hypopharyngeal surgery for management of dysphagia from March 2013 to June 2018 at a single academic institution. A clear liquid diet is restarted the day of surgery and is advanced to a soft diet on postoperative day one. Univariate and multivariate logistic regression was performed to identify risk factors for postoperative complications and unplanned readmission. Results: Ninety patients met eligibility criteria; 62 patients underwent open cricopharyngeal myotomy, 13 underwent Zenker's diverticulectomy, 15 had a Zenker's diverticulopexy. Mean inpatient length of stay was 2.0 ± 2.0 days (range 0-11 days); 57 patients (63.3%) were discharged on the same day as surgery or on postoperative day one. Seven patients (7.8%) had postoperative complications; the most common complication was esophageal leak (n = 6). Six patients (6.7%) had unplanned readmissions within 30 days. Mean time to unplanned readmission was 12 days (range 2-19 days). Open diverticulectomy was associated with an increased risk of unplanned readmission with an OR = 7.63 (95% CI 1.29, 45.45, P = .025). At last follow-up, 70% of patients had an increased functional oral intake by at least one scale score (FOIS) after surgery (mean follow-up 0.8 ± 1.1 years, range 0.02-5.1 years). Conclusion: An early diet and discharge may be safe for patients undergoing open surgery without a mechanical or suture closure of their esophageal mucosa, whereas in those undergoing diverticulectomy, NPO status and a radiological check before resuming drinking and eating are advised. Level of Evidence: 4