title: Predictors of length of stay, reoperation, and readmission following total laryngectomy.
abstract: To identify relevant patient and surgical risk factors associated with prolonged length of stay, return to the operating room, and readmission within 30 days following total laryngectomy using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) STUDY DESIGN: Retrospective database study. Patients undergoing total laryngectomy alone for laryngeal cancer were identified from the ACS-NSQIP database from 2005 to 2014.
  
  
  
  Multivariate logistic regression was used to identify independent predictors for prolonged length of stay, readmissions, and unplanned reoperations within 30 days.
  
  
  
  Among 871 patients meeting inclusion and exclusion criteria, the median length of stay was 8.0 days (range, 0-130 days). Totally dependent functional status (P < .01; odds ratio [OR]: 32.62), Black or African American race (P = .029; OR: 1.75), and operative time (P < .0001; OR: 1.15) were associated with prolonged length of stay. The overall rate of return to the operating room within 30 days was 12.4%. Contaminated wound status (P = .025; OR: 3.53), operative time (P = .015; OR: 1.10), steroid use (P < .01; OR: 2.92), and smoking (P = .05; OR: 1.60) were significantly associated with return to the operating room. Unplanned readmission rate was 11.9%, and 47.37% of readmissions were due to wound infection/pharyngocutaneous fistula. Dirty/contaminated wound classification (P = .05; OR: 22.5) was associated with readmission on multivariate analysis.
  
  
  
  This is the first population-level analysis to be performed on length of stay, readmission, and reoperation for total laryngectomy. Assessing and identifying modifiable risk factors on quality metrics may reduce overall cost and the burden on limited hospital resources.
  
  
  
  4. Laryngoscope, 127:1339-1344, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Helman
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Brant
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York, U.S.A.
authors.forename: Sami P
authors.initials: SP
authors.lastname: Moubayed
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newman
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Cannady
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York, U.S.A.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Chai
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: National Surgical Quality Improvement Program; Total laryngectomy; length of stay; readmission