(0706) Predictors of 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Cancer: A Nationwide Readmissions Database Study

Introduction: Transoral robotic surgery (TORS) is a minimally invasive technique that has dramatically changed the treatment of oropharyngeal cancer. However, postoperative dysphagia and hemorrhage leading to readmission is still a concern. We aimed to identify risk factors that predict readmission after TORS for OPSCC using the Nationwide Readmissions Database (NRD).

Methods: A multi-institutional retrospective cohort analysis of patients undergoing TORS for OPSCC between 2019-2020 was conducted using the NRD database. Patients were selected using a combination of ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes. The primary outcome was 30-day readmission. Patient clinical data were analyzed for their association with readmission using chi-square tests. Binary logistic regression was used to identify independent risk factors associated with increased risk of readmission. Mortality rate on initial visit and readmission was also analyzed.

Results: A total of 1,548 patients were identified from 2019-2020 who had OPSCC and underwent TORS. Of these, 171 (11%) resulted in readmission within 30-days. On univariate analysis, hypertension, atrial fibrillation, atherosclerotic heart disease, radiation, chemotherapy, aspirin/anticoagulant use, VTE, PE, gastrostomy tube and protein-calorie malnutrition were all associated with significantly increased risk of readmission within 30 days. On logistic regression, protein-calorie malnutrition was significantly associated with readmission (OR 2.618, 95% CI 1.345-5.096). The mortality rate on initial postoperative admission was 0.4% (6/148), however this increased to 2.3% (4/171) on readmissions.

Conclusions: Patients with protein-calorie malnutrition are almost three times more likely to be readmitted after TORS, indicating a possible need for preoperative nutritional optimization. Readmission has a higher likelihood of death, thus preventing readmission could improve survival. While other patient factors may play a role in readmission, more studies are needed to better understand risk factors to prevent unnecessary readmission and mortality.