Does discharge location following head and neck cancer surgery affect quality outcomes?

BACKGROUND

Discharge (DC) to post-acute care facilities after head and neck cancer (HNC) surgery is common. Studies in various fields of medicine have shown that DC to facilities is associated with clinical outcomes. Evidence specific to HNC surgery is limited.

OBJECTIVES

This study aimed to evaluate how DC, to either home or a facility, impacts outcomes for patients undergoing HNC surgery.

METHODS

Retrospective cohort study of patients who underwent HNC surgery between January 1, 2014, and January 1, 2023 was performed. Patients were included based on postoperative hospitalization, surgical interventions, and a minimum 30-day follow-up. The primary outcomes were 30-day readmission, 30-day mortality, and postoperative complication severity.

RESULTS

Among 1,895 patients (mean age 63 years, 67% female), 1,554 (82%) were DC home and 341 (18%) to a facility. After adjusting for significant variables, DC site was not associated with readmission (OR 0.94, 95% CI 0.63-1.40), mortality (0.6% home vs 1.5% facility, p = 0.2), or complication severity (mild OR 1.3, p = 0.11; severe OR 1.0, p = 0.92). Factors such as dependency in activities of daily living, tracheotomy presence, surgery severity and prolonged hospitalization were found to be significant covariates in the multivariable analysis for both 30-day readmissions and complication severity. Facility patients had more infections or wound dehiscence (p < 0.05).

CONCLUSION

Although DC to a facility was not significantly associated with worsened outcomes in the multivariable analysis, the findings of this study revealed clinically relevant differences in complication rates and readmission.