Association of a Perioperative Education Program With Unplanned Readmission Following Total Laryngectomy.

Association of a Perioperative Education Program With Unplanned Readmission Following Total Laryngectomy.

JAMA Otolaryngol Head Neck Surg. 2017 Sep 07;:

Authors: Graboyes EM, Kallogjeri D, Zerega J, Kukuljan S, Neal L, Rosenquist KM, Nussenbaum B

Abstract
Importance: Patients undergoing total laryngectomy (TL) are at high risk for 30-day hospital readmission. Strategies to decrease the readmission rate remain unknown.
Objectives: To assess the association of a comprehensive perioperative TL education program with unplanned readmissions; to determine the program's association with the rate of readmissions for stomal or tracheoesophageal puncture (TEP) complications and patient and caregiver knowledge of and preparedness for TL.
Design, Setting, and Participants: This single-institution prospective pilot study was conducted between December 1, 2014, and November 30, 2016, among 50 patients undergoing a perioperative TL education program at a tertiary care academic medical center.
Intervention: The perioperative TL education program consisted of speech-language pathology counseling, a hands-on class with an otolaryngology nurse educator, a TL "Journal Guide" booklet, and a prehospital discharge competency assessment. A family member or friend acting as a laryngectomy coach accompanied patients throughout.
Main Outcomes and Measures: The primary outcome was the rate of 30-day unplanned readmission. Secondary measures included the rate of readmission for stomal or TEP complications and change in knowledge of and preparedness for TL.
Results: Of the 50 patients (12 women and 38 men; median age, 61 years [range, 47-86 years]) who underwent the TL education program, the 30-day unplanned readmission rate was 20% (n=10). Only 1 patient (2%) had a readmission for a stomal or TEP complication. Patients increased their TL knowledge (median improvement in TL knowledge test score, 3.5 [95% CI, 2.8-4.2] of 12) and preparedness (median improvement in TL preparedness score, 3.1 [95% CI, 2.4-3.8] of 10) after undergoing the intervention.
Conclusions and Relevance: This prospective pilot study evaluated an intervention to decrease unplanned readmission in head and neck oncology patients. It provides data indicating that a comprehensive perioperative TL education program is feasible. This program has the potential to decrease 30-day readmission for stomal or TEP complications and merits further study in a larger, multicenter clinical trial.

PMID: 28880984 [PubMed - as supplied by publisher]

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