SB203580 br Previous research has identified a
Previous research has identified a number of pre-, post-, and peri-
Corresponding author at: Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 2450 Holcombe Blvd. Suite 01Y (MS: BCM-288), Houston, TX 77021, USA. E-mail address: [email protected] (H. Badr).
operative variables that are associated with increased health resource use in HNC. For example, pre-operative variables such as older age, poor functional status, comorbidities, and substance use (e.g., tobacco, alcohol) have been associated with prolonged LOS and hospital read-missions [21–23]. A medical history including hypertension, a normal/ underweight BMI, and depressive symptoms have been associated with increased risk for ED presentation . With regard to peri-operative factors, prophylactic percutaneous gastronomy tube (PEG) placement has been associated with lower rates of hospital readmissions [24,25], and airway management with tracheostomy has been associated with prolonged LOS . Finally, in terms of post-operative factors, med-ical/surgical complications (e.g., pneumonia, wound infection, he-morrhage) have been associated with prolonged LOS and readmissions [12,16,22,27]. In fact, in a study of 1058 patients undergoing HNC surgery, Graboyes  found that patients who experienced a com-plication during or after their index hospitalization were 11.9 times more likely than patients without complications to be readmitted to the hospital within 30 days of discharge.
Although a variety of factors have been identified as predicting health resource use in HNC surgical patients, the utility of these find-ings in guiding processes of care has been limited. One possibility is that researchers may not have identified all the variables needed to develop patient risk profiles for increased health resource use. For example, QOL is a multi-dimensional construct of an individual's subjective as-sessment of the impact of an illness or treatment on his or her physical, psychological, social, and somatic functioning and general well-being [28,29]. It represents the gap between one’s functional status and ideal standard . Self-report measures of QOL are patient-centered and have been shown to be consistent predictors of hospitalizations and mortality rates in a variety of chronic diseases (e.g., COPD, SB203580 and kidney disease), even after adjustment for clinically relevant factors [31–33]. QOL is also a critical consideration in the management of HNC, but studies have largely examined it as an outcome of treatment as opposed to a predictor of clinical outcome .
Another factor that may be important for the assessment of risk profiles for increased health resource use in HNC is dysphagia. Dysphagia is a common side eﬀect of HNC and its treatment. Measures of dysphagia include instrumental examinations of swallowing phy-siology and bolus transport, most commonly videofluoroscopy, and patient-reported outcome measures (PROMs). While clinical assessment of dysphagia is valuable in determining extent of mechanical disability, PROMs have gained in popularity among HNC clinicians because they standardize patient reporting of perceived dysphagia and provide in-sights into the impact of swallowing dysfunction on patient QOL . Research in other cancers has shown that routine functional and symptom assessment with PROs may confer clinical benefits including increased rates of symptom discussions between patients and clinicians [36–38], intensified symptom management by clinicians in response to patient reports [38,39], and fewer ER visits and hospitalizations . However, such linkages have yet to be established specifically in HNC. Given the above and the finding that perceptions of both QOL and dysphagia prior to treatment have been associated with survival in HNC , it may be useful to explore the role that pre-surgical QOL and dysphagia could play in predicting post-surgical resource use among patients with HNC.
Another issue that could be aﬀecting the translation of research findings is that insuﬃcient attention has been paid to factors across the entire clinical care pathway when looking at predictors of health re-source use. Instead, studies have largely examined pre-operative or post-operative factors in isolation. Taking a more holistic approach that considers pre-, post-, and intra-operative factors as predictors of dif-ferent types of outcomes (e.g., LOS, ED visits, and readmissions) would be more consistent with the realities of clinical care and could highlight potential targets for quality improvement across the care continuum ranging from treatment planning to hospital discharge. Since assessing and identifying modifiable risk factors on quality metrics may reduce Oral Oncology 90 (2019) 102–108
overall cost and burden on limited hospital resources, this study ex-amined whether pre-, peri-, and post-operative factors predict hospital LOS, thirty-day unplanned hospital readmissions (30dUR), and ED visits in HNC surgical patients.