title: Postdischarge complications predict reoperation and mortality after otolaryngologic surgery.
abstract: OBJECTIVE
  (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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  American College of Surgeons National Surgical Quality Improvement Program (2005-2011).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Chen
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Judson
mesh_terms: D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D061646:Operative Time; D010038:Otorhinolaryngologic Diseases / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: NSQIP; complications; outcomes; post-discharge; quality