Risk Factors for Unplanned Hospital Readmission in Otolaryngology Patients

Abstract

Objectives:

Describe the risk factors that predict 30-day unplanned readmission in hospitalized otolaryngology patients.

Methods:

We conducted a retrospective review of all otolaryngology admissions for the one year period between January 1, 2011, and December 31, 2011, at a single academic medical center with a broad and heterogeneous otolaryngology practice. A univariate logistic regression and then a forward stepwise logistic regression model were performed to identify risk factors for unplanned readmission to the hospital within thirty days of discharge from the otolaryngology service.

Results:

1271 patients met inclusion criteria. The 30-day unplanned readmission rate for patients discharged from otolaryngology was 7.3% (93/1271). There were twenty variables that were significant on univariate analysis. The risk factors for readmission after the forward stepwise logistic regression model were new total laryngectomy (Odds Ratio (OR) 5.5) (95% Confidence Interval (CI) 2.1; 14.6), prior unplanned readmission from any service at the academic center (OR 3.1) (95% CI 1.9; 5.1), current illicit drug use (OR 3.4) (95% CI 1.8, 6.4), preoperative non-steroidal immunosuppression (OR 3.4) (95% CI 1.4; 8.4), discharge to an extended care facility or skilled nursing facility (OR 3.4) (95% CI 1.6; 7.1), and discharge to home with home healthcare (OR 2.3) (95% CI 1.2; 4,4). The c-index for the regression model was 0.73.

Conclusions:

Otolaryngology patients have unique risk factors that predict unplanned readmission within 30-days of discharge. These data identify specific patient characteristics and care processes that can be targeted with quality improvement interventions to decrease readmissions.