The effect of pneumonia on short-term outcomes and cost of care after head and neck cancer surgery. Laryngoscope

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
The Laryngoscope (Impact Factor: 2.14). 09/2012; 122(9):1994-2004. DOI: 10.1002/lary.23446
Source: PubMed


The Centers for Medicare and Medicaid Services has threatened to discontinue reimbursements for ventilator-associated pneumonia (VAP) as a preventable "never event." We sought to determine the relationship between pneumonia and in-hospital mortality, complications, length of hospitalization and costs in head and neck cancer (HNCA) surgery.
Retrospective cross-sectional study.
Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm from 2003 to 2008 were analyzed using cross-tabulations and multivariate regression modeling.
VAP was rarely coded. Infectious pneumonia was significantly associated with chronic pulmonary disease (odds ratio [OR], 1.5; P < .001), while aspiration pneumonia was associated with dysphagia (OR, 2.0; P < .001). Pneumonia from any cause was associated with weight loss (OR, 3.3; P < .001), age >80 years (OR, 2.0; P = .007), comorbidity (OR, 2.3; P < .001), and major procedures (OR, 1.6; P < .001), with increased in-hospital mortality for infectious (OR, 2.9; P < .001) and aspiration pneumonia (OR, 5.3; P < .001). Both infectious and aspiration pneumonia were associated with postoperative medical and surgical complications, increased length of hospitalization, and hospital-related costs.
Postoperative pneumonia is associated with increased mortality, complications, length of hospitalization, and hospital-related costs in HNCA surgical patients. Variables associated with an increased risk of pneumonia are inherent comorbidities in HNCA and known risk factors for VAP, making this a high-risk group for this never event. Caution must be used in the institution of reforms that threaten to inadequately reimburse the provision of care to this vulnerable population. Aggressive preoperative identification and treatment of underlying pulmonary disease, weight loss, and dysphagia may reduce morbidity and mortality.

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    • "Post-treatment pneumonia was associated with increased medical costs in studies conducted in France, Taiwan, and the USA [16, 49, 59]. In the French prospective cohort study, post-operative pneumonia added €19,000 of direct medical costs to treatment. "
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    • "For example, patients undergoing major cardiac surgery are likely to be intubated during the initial recovery; however, in general, these patients are expected to be extubated within a number of hours and should be at relatively low risk for hospital-acquired pneumonia. In fact, early extubation is a major goal for teams caring for postoperative cardiac surgery patients [28] "
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