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Original Investigation |

Risk Factors Associated With Unplanned Readmission in Patients Undergoing Parotid Cancer Surgery A Study of the National Cancer Database

Kevin Y. Zhan, MD1; Evan M. Graboyes, MD2; Shaun A. Nguyen, MD, MA1; Terry A. Day, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head & Neck Surgery, Medical University of South Carolina, Charleston
2Department of Otolaryngology–Head & Neck Surgery, School of Medicine, Washington University, St Louis, Missouri
JAMA Otolaryngol Head Neck Surg. 2016;142(6):544-550. doi:10.1001/jamaoto.2016.0216.
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Importance  Thirty-day unplanned readmissions are increasingly used as a measure of quality care.

Objective  To describe the incidence of and risk factors for 30-day unplanned readmissions for patients undergoing treatment for cancer of the parotid gland.

Design, Setting, and Participants  A retrospective cohort study was conducted using the National Cancer Database. Records on patients in the database undergoing surgery for previously untreated primary parotid cancer between 2003 and 2012 were reviewed. The data were analyzed in October 2015.

Interventions  Parotidectomy with or without neck dissection.

Main Outcomes and Measures  The main outcome measure was patient-, area-, and hospital-level risk factors for readmission. Secondary outcome measures were the rate of 30-day unplanned readmission and the rate of 30-day mortality.

Results  We identified 11 394 cases of previously untreated parotid cancer undergoing definitive surgery. The 30-day unplanned readmission rate following parotidectomy was 2.1% (235 of 11 394 surgical procedures). Reported as odds ratios (95% CIs), factors associated with the 30-day unplanned readmission rate on multivariable analysis included advanced pathologic T category (1.59 [1.14-2.20]), uninsured status (2.27 [1.07-4.80]), and increased morbidity as measured by the Charlson/Deyo Score (CDS) (CDS 1, 1.57 [1.05-2.35]; CDS >1, 2.08 [1.06-4.08]). Thirty-day unplanned readmission was associated with an 8.4-fold (8.36 [2.04-34.30]) increased risk of 30-day mortality (1.9% vs 0.2%).

Conclusions and Relevance  Thirty-day unplanned readmission following surgery for parotid cancer is not common. Risk factors associated with 30-day unplanned readmission include pathologic T category, comorbidity, and uninsured status. Having an unplanned 30-day readmission is associated with greater risk of 30-day mortality.

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