Impact of rehabilitation facility on outcomes in head and neck surgical patients

Abstract

Objectives: To determine the significance of in-hospital rehabilitation facility versus distant rehabilitation facilities in the outcomes and complications of postoperative head and neck surgical patients. Methods: Retrospective review of head and neck surgical patients over a 5-year period at a tertiary care medical center. Results: Fifty patients met criteria for this study (35 males, 15 females). Forty-two patients had a primary squamous cell carcinoma, and 8 patients had other primary malignancy of the head and neck. Thirty-two patients were placed in an in-hospital rehabilitation facility, and 18 patients were placed in distant rehabilitation facilities (average distance 40.9 miles; range 2–250 miles). Seventeen patients (34%) had complications including infection/drainage (7 patients), fistula (6 patients), pneumonia (2 patients), wound dehiscence (2 patients), bleeding from carotid stump, fluctuance, exudate, ulcer, eschar, delay in Blom-Singer valve teaching and displacement. The difference between the rate of complications among the 2 groups was not statistically significant (37.5% in-hospital rehabilitation, 27.8% distant rehabilitation; P = 0.496). The difference between the rate of hospital readmission was not statistically significant either (25% for in-hospital rehabilitation patients and 16.7% for distant rehabilitation patients; P = 0.505). The average length of stay of patients without complications was 18.5 days (SD = 17) for in-hospital rehabilitation and 12.9 days (SD = 5.8) for distant rehabilitation. This difference was not statistically significant ( P = 0.346). Conclusion: One third of postoperative head and neck surgical patients developed complications while in a rehabilitation facility. The length of stay, hospital re-admission rate, and frequency of complications does not correlate with the distance of the rehabilitation facility from the treating institution.