title: Prevalence and Patient-Level Risk Factors for 30-Day Readmissions Following Free Tissue Transfer for Head and Neck Cancer.
abstract: OBJECTIVE
  Hospital readmissions are a marker of surgical care delivery and quality that are progressively more scrutinized.
  
  
  OBJECTIVE
  To provide a comprehensive analysis of 30-day readmissions for patients with head and neck cancer who underwent free flap reconstruction to highlight the rate, causes, and associated patient risk factors.
  
  
  METHODS
  Retrospective cohort study at a single tertiary care academic institution. The study consisted of 249 patients who underwent microvascular reconstruction of a presumed head and neck oncologic defect from January 1, 2000, through June 30, 2014. Follow-up continued through July 30, 2014.
  
  
  METHODS
  Microvascular reconstruction of an oncologic head and neck defect.
  
  
  METHODS
  Incidence of 30-day all-cause readmissions, patient risk factors, and readmission indications. Regression analyses were conducted to discern patient-level risk factors related to 30-day readmissions.
  
  
  RESULTS
  Among the 249 patients, the 30-day all-cause readmission rate was 14.5%, while the unplanned readmission rate was 11.6%. The most common reason for readmission was neck wound complications. Predictors of readmission following multivariable analysis were T4 pathologic stage (odds ratio [OR], 11.68; 95% CI, 1.37-99.81; P = .02) and having a tumor located in the oropharynx (OR, 4.64; 95% CI, 1.89-11.38; P = .001), hypopharynx (OR, 8.30; 95% CI, 1.52-45.24; P = .01), or larynx (OR, 10.97; 95% CI, 2.27-52.98; P = .003). Patients who were readmitted were more likely to experience neck wound complications (OR, 5.07; 95% CI, 1.31-19.57; P = .02) and undergo reoperation (OR, 47.20; 95% CI, 8.33-267.33; P < .001).
  
  
  CONCLUSIONS
  In this study, advanced pathologic tumor staging and tumor location were associated with 30-day readmissions in patients with head and neck cancer who receive free flaps. Our results provide a benchmark for risk stratification that can be used in system-based practice improvements, health care cost savings, and postoperative patient counseling.
authors.affiliation: Department of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Anaeze C
authors.initials: AC
authors.lastname: Offodile
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Abraham
authors.initials: A
authors.lastname: Pathak
authors.affiliation: Division of Nephrology, Massachusetts General Hospital, Boston.
authors.forename: Julia
authors.initials: J
authors.lastname: Wenger
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
authors.affiliation: Department of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Lifei
authors.initials: L
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D015984:Causality; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects* / Q000706:statistics & numerical data*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D010039:Otorhinolaryngologic Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors