title: Discharge Destination after Head and Neck Surgery: Predictors of Discharge to Postacute Care.
abstract: In recent decades, there has been a reduction in the length of postoperative hospital stay, with a corresponding increase in discharge to postacute care. Discharge to postacute care facilities represents a meaningful patient-centered outcome; however, little has been published about this outcome after head and neck surgery.
  
  
  
  Retrospective review of national database.
  
  
  
  American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2013.
  
  
  
  We compared the rate of discharge to home versus postacute care facilities in patients admitted after head and neck surgery and used multivariable logistic regression to identify predictors of discharge to postacute care.
  
  
  
  The overall rate of discharge to postacute care facilities after head and neck surgery (n = 15,890) was 15.7% after major surgery (including laryngectomy, composite resection, and free tissue transfer), 4.4% after moderate surgery (including regional tissue transfer, oropharyngeal or oral cavity resection, and neck dissection), and 1.1% after minor head and neck surgery (including endocrine or salivary gland surgery). On multivariable analysis, significant preoperative predictors of discharge to postacute care were advanced age, functional status, major or moderate surgical procedures, tracheostomy, advanced American Society of Anesthesiologists class, low body mass index, and dyspnea.
  
  
  
  Our study indicates that patients undergoing major or moderate head and neck surgery, patients with reduced functional status, and patients with advanced comorbidities are at substantial risk of discharge to postacute care. The possibility of discharge to postacute care should be discussed with high-risk patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA John.cramer@northwestern.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Cramer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Division of Otolaryngology Head and Neck Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA.
authors.forename: Urjeet A
authors.initials: UA
authors.lastname: Patel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Samant
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shintani Smith
mesh_terms: D017677:Age Distribution; D016208:Databases, Factual; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011184:Postoperative Period; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects; D019467:Subacute Care / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: National Surgical Quality Improvement Program; discharge disposition; head and neck neoplasms; postacute care; surgery