The effect of pneumonia on short-term outcomes and cost of care after head and neck cancer surgery.
BACKGROUND
The Centers for Medicare and Medicaid Services has threatened to discontinue reimbursements for ventilator-associated pneumonia (VAP) as a preventable "never event." We sought to determine the relationship between pneumonia and in-hospital mortality, complications, length of hospitalization and costs in head and neck cancer (HNCA) surgery.


METHODS
Retrospective cross-sectional study.


METHODS
Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm from 2003 to 2008 were analyzed using cross-tabulations and multivariate regression modeling.


RESULTS
VAP was rarely coded. Infectious pneumonia was significantly associated with chronic pulmonary disease (odds ratio [OR], 1.5; P < .001), while aspiration pneumonia was associated with dysphagia (OR, 2.0; P < .001). Pneumonia from any cause was associated with weight loss (OR, 3.3; P < .001), age >80 years (OR, 2.0; P = .007), comorbidity (OR, 2.3; P < .001), and major procedures (OR, 1.6; P < .001), with increased in-hospital mortality for infectious (OR, 2.9; P < .001) and aspiration pneumonia (OR, 5.3; P < .001). Both infectious and aspiration pneumonia were associated with postoperative medical and surgical complications, increased length of hospitalization, and hospital-related costs.


CONCLUSIONS
Postoperative pneumonia is associated with increased mortality, complications, length of hospitalization, and hospital-related costs in HNCA surgical patients. Variables associated with an increased risk of pneumonia are inherent comorbidities in HNCA and known risk factors for VAP, making this a high-risk group for this never event. Caution must be used in the institution of reforms that threaten to inadequately reimburse the provision of care to this vulnerable population. Aggressive preoperative identification and treatment of underlying pulmonary disease, weight loss, and dysphagia may reduce morbidity and mortality.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Yevgeniy R
YR
Semenov
Heather M
HM
Starmer
Christine G
CG
Gourin
D000046:Academic Medical Centers; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017721:Hospital Costs; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008396:Maryland; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D016017:Odds Ratio; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D011182:Postoperative Care / Q000191:economics / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome