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Otolaryngol Head Neck Surg. 2013 Dec;149(6):865-72. doi: 10.1177/0194599813505078. Epub 2013 Sep 18.

Postdischarge complications predict reoperation and mortality after otolaryngologic surgery.

Author information

1
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.

Abstract

OBJECTIVES:

(1) Determine procedure-specific rates of postdischarge complications (PDCs) and their risk factors in the first 30 days following inpatient otolaryngologic surgery. (2) Evaluate association between PDCs and risk of reoperation and mortality.

STUDY DESIGN:

Retrospective cohort study.

SETTING:

American College of Surgeons National Surgical Quality Improvement Program (2005-2011).

SUBJECTS AND METHODS:

We identified 48,028 adult patients who underwent inpatient otolaryngologic surgery. Outcomes of interest included complications, reoperation, and mortality in the first 30 days following surgery. Statistical analysis included chi-square, t tests, and multivariate regression.

RESULTS:

Laryngectomy, lip, and tongue/floor of mouth surgery had the highest PDC rates (8.0%, 7.4%, and 4.1%, respectively). Within the first 48 hours, week, and 2 weeks post discharge, 10%, 44%, and 73% of PDCs occurred, respectively. Common PDCs included surgical site infections (53.6%), other infections (37.4%), and venous thromboembolic events (7.4%). Multivariate analysis demonstrated that increasing age (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.01-1.02), prolonged operative time (OR = 1.68; 95% CI, 1.39-2.03), hospital stay >1 day (OR = 1.49; 95% CI, 1.18-1.86), and American Society of Anesthesiologists (ASA) class ≥ 3 (OR = 1.45; 95% CI, 1.18-1.78) were independently associated with PDCs. Patients with PDCs were more likely to die (0.9% vs 0.1%, P < .001) or have a reoperation (10.4% vs 1.2%, P < .001).

CONCLUSION:

This is the first study of overall postdischarge events after otolaryngologic surgery. PDC rates in otolaryngology occur soon after discharge, are procedure specific, and are associated with reoperation and mortality. Targeted procedure-specific triage and follow-up plans for high-risk patients may improve outcomes.

KEYWORDS:

NSQIP; complications; outcomes; post-discharge; quality

PMID:
24047818
DOI:
10.1177/0194599813505078
[Indexed for MEDLINE]

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