title: Tracheostomy and infection prolong length of stay in hospital after surgery for head and neck cancer: a population based study.
abstract: OBJECTIVE
  To determine the factors that predict length of stay (LOS) in hospital after head and neck cancer (HNC) surgery for patients treated in public hospitals in Ireland between 2002 and 2010.
  
  
  METHODS
  Cancer registry data on patients with carcinoma of the oropharynx/larynx were identified and linked with hospital in-patient discharge records. Associations between clinical (e.g., surgery type, neoadjuvant chemoradiation), health service factors, and LOS were investigated by using negative binomial regression.
  
  
  RESULTS
  Of the patients diagnosed with HNC, 50% (n = 1651) underwent HNC surgery. Median LOS was 10 days (range: 1-289). Variables associated with prolonged LOS included tracheostomy (neck dissection + tracheostomy versus neck dissection only: incident rate ratio [IRR] 2.66; 95% confidence interval [CI] 2.01-3.50); postoperative infection (IRR 2.26; 95% CI 1.94-2.62); and neoadjuvant radiotherapy (IRR 2.15; 95% CI 1.64-2.82). Advanced stage, gastrostomy, and reconstruction were also associated with prolonged LOS.
  
  
  CONCLUSIONS
  Tracheostomy and postoperative infection were associated with prolonged LOS. Further investigation of these modifiable risk factors is warranted.
authors.affiliation: National Cancer Registry, Cork, Ireland. Electronic address: j.mcdevitt@ncri.ie.
authors.forename: Joseph
authors.initials: J
authors.lastname: McDevitt
authors.affiliation: National Cancer Registry, Cork, Ireland.
authors.forename: Marianna de Camargo
authors.initials: Mde C
authors.lastname: Cancela
authors.affiliation: National Cancer Registry, Cork, Ireland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kelly
authors.affiliation: National Cancer Registry, Cork, Ireland.
authors.forename: Harry
authors.initials: H
authors.lastname: Comber
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014139:Tracheostomy