In 2010, The Patient Protection and Affordable Care Act (PPACA) identified 30-day unplanned hospital readmissions, which account for $15 billion, as a contributing factor to Medicare over-spending (Head Neck. Mar 9, 2015. doi: 10.1002/hed.24030). Overall, hospital 30-day unplanned readmission rates range from 10% to 30%, with a national average of approximately 20%. Sizeable increases in research efforts are now aimed at identifying risk factors for early readmissions across a breadth of surgical populations (JAMA Otolaryngol Head Neck Surg. July 23, 2015. doi:10.1001/jamaoto.2015.1323).
Explore this issue:October 2015
So, where do readmission rates related to otolaryngology fall? In a study conducted by Jain and colleagues, outpatient otolaryngological surgery had a 2.01% unplanned readmission rate. This rate was lower than those of surgical specialties such as outpatient general (2.4%), cardiac (6.3%), neurological (3.1%), thoracic (5.8%), urologic (3.7%), and vascular surgeries (4.3%), but higher than gynecological (1.8%), orthopedic (1.2%), and plastic outpatient procedures (1.9%).
“The differences in unplanned readmissions rates between surgical specialties may partly be due to the differing anatomic location and various degrees of surgical invasiveness associated with different surgeries,” said Stephanie Shintani Smith, MD, MS, assistant professor at Northwestern University Feinberg School of Medicine in Chicago, and a co-author of the study. “While otolaryngology surgeries center on the ear, nose, throat, head, and neck, other surgical procedures focus on deeper regions of the body that are at a higher risk for bacterial infection. Procedures that utilize endoscopic/laparoscopic techniques are less invasive and may be less time consuming, so they may have lower complication rates.”
The unplanned readmission rate of 2.01% associated with outpatient otolaryngological surgery was lower than the 4.8% rate seen in inpatient otolaryngological procedures from the same dataset in the Jain study (Laryngoscope. 2014;124:1783-1788). “Outpatient surgical candidates are often healthier and have a lower risk for post-operative complications than their inpatient counterparts,” the study authors stated. “Additionally, outpatient procedures are often shorter and less complicated than inpatient procedures.”
Another study showed that the risk factors associated with readmission for patients with head and neck cancer who underwent free-flap reconstruction were T4 tumor and oropharyngeal/hypopharyngeal/laryngeal tumors. The 30-day all-cause readmission rate for these patients was 14.5% overall, with an 11.6% unplanned readmission rate. The most common reason for readmission was neck and wound complications (Laryngoscope. 2014;124:1783-1788).
In a study conducted by Dziegielewski and colleagues, of 607 patients who underwent 660 operations by a head and neck surgery service, 7.3% were readmitted within 30 days. Of these, 17% had post-discharge complications within 30 days of discharge. Specifically, 9.8% were minor and included seromas, cellulitis, skin graft breakdown, and minor wound dehiscence. None of these patients were readmitted; however, 7.3% had significant complications and were readmitted. Reasons for readmission included wound infection (31%), surgical site bleeding episodes (19%), medical complications including renal failure, dehydration, urinary retention, and upper gastrointestinal bleeding (19%), pneumonia (13%), fistulae (10%), airway obstruction (6%), and social reasons (2%). The 30-day readmission rate resulted in $1.68 million of additional healthcare spending (JAMA Otolaryngol Head Neck Surg. July 23, 2015. doi:10.1001/jamaoto.2015.1323).