Multiprofessional Assessment and Information Day Associated With Shortened Hospital Stay Following Complex Oncologic Head and Neck Surgery

Decreased length of hospital stay, costs, and complication severity were associated with used of preoperative multiprofessional assessment and information day (MUPAID) in patients undergoing complex oncologic head and neck surgery, according to results from a case-controlled study published in JAMA Otolaryngology-Head & Neck Surgery.

Patients who received MUPAID had a shorter median hospital stay of 12 days compared with 16 days for those who did not (effect size, 0.482; 95% Cohen d, 0.152-0.812). Median cost was also lower in the intervention cohort at $50,848 compared with $69,602 in the control cohort (effect size, 0.534; 95% Cohen d, 0.22-0.85).

MUPAID is held weekly in all patients undergoing complex oncologic head and neck surgery being referred by an internal interdisciplinary board. MUPAID was designed based on standardized risk assessments and information packages that were developed based on data gathered by professionals, consisting of research evidence and expert insights. Moreover, should further surgical disciplines be required aside from the planned surgery, the patient was presented to a board of professionals consisting of head and neck, maxillofacial, and plastic reconstructive surgeons.

A total of 161 patients were included in the study, of whom 50.3% were in the intervention cohort and 49.7% in the control cohort. The majority of patients were male (73%) with advanced stage disease, 80% were smokers, and 59.6% had comorbidities. The most common type of surgery received was ablative surgery with flap reconstruction followed by laryngectomy.

A total of 84% of patients in the intervention cohort presented with 1 or more local and/or systemic deviation or complication with a Clavian-Dindo grade of 1 or more compared with 83% in the control group. Major complications requiring surgery or intensive treatment occurred in 52.5% of patients in the control group compared with 34.6% in the intervention group. Between the intervention and control cohorts, the most common local complications were flap dehiscence (22.7% vs 16.7%), wound infections (13.6% vs 17.5%), and hemorrhage (18.5% vs 12.5%). Systemic complications included refeeding syndrome (46.9% vs 55.0%), and respiratory problems (7.4% vs 22.5%) in the intervention and control cohorts, respectively.

The multivariate analysis showed that those who received MUPAID had a 60% reduction (odds ratio 0.39; 95% CI, 0.19-0.76) in the development complications compared with the control cohort. The use of free flaps resulted in a doubling of complication compared with the use of pedicled flap.

In the intervention group, patients had a shorter length of hospital stay, which included initial hospitalization and readmission within 30 days after discharge vs the control group. Investigators did not observe a meaningful difference in readmission rates within 30 days after discharge, including a rate of 8.6% in the intervention cohort and 12.5% in the control cohort being readmitted. In the intervention cohort, patients were commonly readmitted to the hospital because of wound infection (28.6%), flap dehiscence (14.3%), flap necrosis (14.3%), dyspnea from cardiac insufficiency (14.3%), pneumonia with sepsis (14.3%), and a fall after a complicated postoperative course (14.3%). Moreover, frequent reasons for readmission in the control group were wound infection (20%), bleeding/hematoma (20%), dyspnea from tracheostomy management issues (20%), metabolic issues (20%), seroma (10%), and flap necrosis (10%).

A total of 2 patients died per group with deatsh occurring on the postoperative days 25 and 30 in the intervention group and 15 and 20 in the control group. Additional charges from MUPAID ranged from $462 to $1805 and were depended on the number of disciplines included in MUPAID; the average cost was $1176 per MUPAID. Investigators could not determine the costs for the control group because of data not being collected prior to MUPAID implementation.

Reference

Schmid M, Giger R, Nisa L, Mueller SA, Schubert M, Schubert AD. Association of multiprofessional preoperative assessment and information for patients with head and neck cancer with postoperative outcomes. JAMA Otolaryngol Head Neck Surg. 2022;148(3):259-267. doi:10.1001/jamaoto.2021.4048