Post‐discharge Complications Predict Reoperation and Mortality after Otolaryngology Surgery

Abstract

Objectives: 1) Determine procedure-specific rates of post-discharge complications and their risk factors in the first 30 days following inpatient otolaryngology surgery. 2) Evaluate association between post-discharge complications and risk of reoperation. Methods: A retrospective cohort study of the ACS-NSQIP database (2005-2011) was used to identify 48,028 adult patients who underwent one of eight groups of inpatient otolaryngology procedures and examine demographic and clinical characteristics. Outcomes of interest included postoperative complications, unplanned reoperation, and mortality in the first 30 days following surgery. Statistical analysis included chi-square tests, student’s t tests, and multivariate logistic regression. Results: Laryngectomy, lip, and tongue/floor of mouth surgery had the highest post-discharge complication rates (8.0%, 7.4%, and 4.1%, respectively). The most common complications were surgical site infections (46.4%), other infections (33.4%), and venous thromboembolic events (7.4%). Multivariate analysis demonstrated that increasing age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.02), longer operative time (OR, 1.64; 95% CI, 1.34-2.01), hospital stay >1 day (OR, 1.49; 95% CI, 1.20-1.86), and American Society of Anesthesiologists (ASA) class >3 (OR, 1.46; 95% CI, 1.19-1.79) were independently associated with post-discharge complications. Patients with complications were more likely to die (0.9% vs 0.1%, P< .001) or have a reoperation (10.4% vs 1.2%, P< .001). On multivariate analysis, post-discharge complications were independently associated with reoperation (OR, 6.55; 95% CI, 3.94-10.87). Conclusions: This is the first study of overall post-discharge events after otolaryngology surgery. Post-discharge complication rates in otolaryngology are procedure-specific and associated with reoperation. Targeted procedure-specific triage and follow-up plans for high-risk patients could improve outcomes.