Rates Of Unplanned Hospital Admissions Research Articles

Impact of Interventions by a Registered Dietitian on Nutritional Outcomes in Head and Neck Cancer Patients Undergoing Radiotherapy

Weight loss and general poor nutritional status are common problems in head and neck cancer patients that adversely affect quality of life and that can potentially reduce the efficacy of treatment. Both radiotherapy (RT) and chemotherapy (CT) accentuate these difficulties. Previous studies have shown that formal interventions by registered dietitians (RD) positively influence the nutritional status of cancer patients, mitigate against weight loss with improved quality of life, and potentially influence overall treatment outcomes. In 2005, a RD was hired in the Radiation Oncology department at Duke University Medical Center. Nutritional outcomes of head and neck cancer patients treated after her arrival were retrospectively compared with outcomes of patients treated prior to her arrival. Patients undergoing RT +/− concurrent CT for squamous carcinoma of the head and neck were seen for formal interventions with a RD (Intervention group I: n = 101). They were matched by tumor site, stage, and treatment delivered with patients who did not undergo such interventions (Matched group M: n = 109). 8 of the I patients were double matched to 16 M patients to include more patients on clinical trials in the study (n = 42 total). 61% of patients received RT and concurrent CT and 39% received RT alone. Most of the tumors (69%) arose from the oropharynx or larynx. Body mass index before, during, and after therapy, feeding tube intervention, and frequency of unplanned hospital admissions (for dehydration or uncontrolled nausea and vomiting) were measured. The patients in group I were seen an average of 4 times by a RD during the course of therapy. The number of feeding tubes placed in the I (n = 29) and M (n = 27) groups were similar. However, in the I group, 20/29 (69%) of the feeding tubes were placed after the 4th week of therapy, while 17/27 (37%) were placed prior to Week 4 in the M group. Total unplanned hospital admission rates were significantly higher in the M group 63/109 (57%) than in the I group 29/101 (29%), chi-square p < 0.001. Unplanned hospital admission rates were higher in patients receiving CT, although the frequency was lesser in those who received nutrition intervention (I=23/71, 32%; M=34/58, 59%; chi-square p < 0.003). Mean weight loss did not vary between the two groups either during or after therapy. Intervention by a RD was associated with a decrease in rates of unplanned hospital admissions. This may reflect more aggressive clinical nutritional management of the side effects of the cancer therapies. Ongoing prospective evaluation of quality of life and general oncologic outcomes are underway.

HN11P PRIMARY CHEMO‐RADIOTHERAPY FOR NON‐METASTATIC SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

Purpose To review our experience of concomitant single agent cheoradiotherapy treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN).Methodology A retrospective cohort study of 56 patients with advanced SCCHN. Patients were eligible for inclusion if they had been treated with primary concurrent chemoradiotherapy for squamous cell carcinoma of the oral cavity (p = 7%), oropharynx (p = 54%), larynx (p = 23%) or hypopharynx (p = 16%) at the Sydney Head and Neck Cancer Institute between 2000 and 2005. Patients treated previously for this disease, or with other agents (such as 5‐FU) in combination with cisplatin/carboplatin, were excluded. Treatment was 80 or 100 mg/m2 of cisplatin in weeks 1, 4 and 7 of radiotherapy. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 86% of patients.Results A 90% initial complete response rate was observed. The Kaplan‐Meier 3 year projected overall survival rate was 72% and 3‐year disease specific survival was 74%. Eleven percent of the patient cohort underwent salvage surgery while 14% required chemotherapy dose adjustments. Twenty percent of patients required unplanned hospital admission for the management of treatment related toxicity.Conclusion Our study affirms that our overall survival rates and treatment related toxicities, using a concomitant chemoradiotherapy protocol are comparable with other institutions. Our initial clinical response rates may reflect our selection criteria and the low percentage of patients requiring dose adjustments. Our low rate of unplanned hospital admissions may be explained by the routine use of PEG tubes to reduce treatment related complications.

The diagnosis of obstructive sleep apnea as a risk factor for unanticipated admissions in outpatient surgery.

The goal of this study was to determine whether the preoperative diagnosis of obstructive sleep apnea (OSA) is an independent risk factor for perioperative complications in patients undergoing nonotorhinolaryngologic outpatient surgical procedures. We used existing databases to identify 234 patients with polysomnography-confirmed OSA who had outpatient surgical procedures in the years 1997 through 2000. Control patients were matched for type of anesthesia, age, sex, body mass index, surgical procedure, and surgical date. Their perioperative medical records were reviewed. There was no significant difference in the intraoperative management of OSA and control patients, except that the laryngeal mask airway was less likely to be used in OSA patients. There was no significant difference in the rate of unplanned hospital admissions (23.9% versus 18.8%; odds ratio, 1.4; 95% confidence interval, 0.8-2.5) or other adverse events (2.1% versus 1.3%; odds ratio, 1.7; 95% confidence interval, 0.4-7.0) between OSA and non-OSA patients. Further, when admission did occur, it was generally unrelated to cardiac or respiratory events. In this retrospective analysis, the preoperative diagnosis of OSA was not a risk factor for either unanticipated hospital admission or for other adverse events among patients undergoing outpatient surgical procedures in a tertiary referral center. In patients scheduled for outpatient surgery in a large academic practice, the diagnosis of obstructive sleep apnea confirmed by polysomnography was not an independent risk factor for unanticipated hospital admission or for other adverse perioperative events.