Predictors of surgical readmission, unplanned hospitalization and emergency department use in head and neck oncology: A systematic review

Christopher W Noel; David Forner; Vincent Wu; Danny Enepekides; Jonathan C Irish; Zain Husain; Kelvin K W Chan; Julie Hallet; Natalie Coburn; Antoine Eskander

doi:10.1016/j.oraloncology.2020.105039

Predictors of surgical readmission, unplanned hospitalization and emergency department use in head and neck oncology: A systematic review

Oral Oncol. 2020 Dec:111:105039. doi: 10.1016/j.oraloncology.2020.105039. Epub 2020 Oct 23.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
³ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
⁶ Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁷ Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
⁸ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
⁹ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada. Electronic address: antoine.eskander@mail.utoronto.ca.

PMID: 33141060
DOI: 10.1016/j.oraloncology.2020.105039

Abstract

Objective: To identify predictors of unplanned hospitalization and emergency department (ED) use among head and neck oncology patients.

Methods: Peer reviewed publications were identified through a systematic search of MEDLINE, Embase and Cochrane CENTRAL. Studies describing a cohort of HNC patients that detailed predictors of unplanned hospitalization or ED use in risk-adjusted models were eligible for inclusion. The methodologic quality of included studies was assessed using the Quality In Prognostic Studies (QUIPS) tool and an adapted version of the GRADE framework.

Results: Of the 932 articles identified, 39 studies met our inclusion criteria with 31/39 describing predictors of surgical readmission and 10/39 describing predictors of ED use or unplanned hospitalization during radiation/chemoradiation treatment. Risk factors were classified into either 'patient-related', 'cancer severity' or 'process' factors. In the subset of studies looking at readmission following surgery wound complications (10/14 studies), presence of comorbidity (16/28 studies), low socioeconomic status (8/17 studies), cancer stage (9/14 studies), and prolonged hospital stay (7/18 studies) were the variables most frequently associated with readmission on multivariable analysis. Presence of comorbidity (6/10) and chemotherapy use (4/10) were more frequently associated with ED use and unplanned hospitalization.

Conclusions: Several consistent predictors have been identified across a variety of studies. This work is a critical first step towards the development of readmission and ED prediction models. It also enables meaningful comparison of hospital readmission rates with risk adjustment in HNC patients.

Keywords: Complications; Emergency department quality of care; Emergency health service; Emergency service; Head and neck cancer; Head and neck neoplasms; Hospitalization; Quality metrics; Readmission.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Age Factors
Antineoplastic Agents / therapeutic use
Chemoradiotherapy
Comorbidity
Emergency Service, Hospital / statistics & numerical data*
Female
Head and Neck Neoplasms / pathology
Head and Neck Neoplasms / therapy*
Health Services Needs and Demand / statistics & numerical data
Hospitalization / statistics & numerical data*
Humans
Length of Stay
Male
Patient Readmission / statistics & numerical data*
Postoperative Period
Radiotherapy
Risk Factors
Rural Population
Sex Factors
Socioeconomic Factors
Surgical Wound / complications
Weight Loss

Substances

Antineoplastic Agents

Grants and funding

CIHR/Canada