Thirty-day readmission in patients undergoing head and neck microvascular reconstruction

Head Neck. 2018 Jul;40(7):1366-1374. doi: 10.1002/hed.25107. Epub 2018 Mar 1.

Abstract

Background: Characteristics of 30-day unplanned readmissions after head and neck microvascular reconstruction remain poorly understood.

Methods: We conducted a retrospective cohort of patients who underwent head and neck microvascular reconstruction between 2010 and 2015.

Results: The 30-day unplanned readmission rate was 13.0% (64/493). The most common readmission diagnoses were dehiscence, surgical site infection, or fistula (45.3%; n = 29). Of the readmissions, 46.9% (30/64) occurred within 7 days of discharge from the hospital. Risk factors for readmission on multivariable analysis included body mass index (BMI) < 21 kg/m (odds ratio [OR] 2.47; 95% confidence interval [CI] 1.36-4.47), primary site of oropharynx (OR 1.66; 95% CI 1.17-6.06), hypopharynx/larynx (OR 3.66; 95% CI 1.70-7.88), or sinonasal/skull base (OR 4.07; 95% CI 1.43-11.55), and fistula during the index hospitalization (OR 2.98; 95% CI 1.22-7.24).

Conclusion: More than 1 in 10 patients undergoing head and neck microvascular reconstruction has a 30-day unplanned readmission, most commonly related to wound complications. Further efforts are needed to determine optimal 30-day unplanned readmission reduction strategies.

Keywords: complications; free flap; microvascular; quality; readmission.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Body Mass Index
  • Cohort Studies
  • Female
  • Fistula / epidemiology
  • Free Tissue Flaps*
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Male
  • Middle Aged
  • Osteoradionecrosis / surgery*
  • Patient Readmission / statistics & numerical data*
  • Postoperative Complications / epidemiology
  • Reconstructive Surgical Procedures / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Young Adult