Factors associated with readmission following reconstruction in head and neck skin cancer: a national readmission database analysis

BACKGROUND: Readmission following reconstructive surgery for head and neck skin cancer is associated with increased morbidity and healthcare costs. However, risk factors in this population are poorly defined. This study aimed to evaluate the incidence, causes, and predictors of 90-day unplanned readmission following reconstructive surgery for head and neck skin cancer. METHODS: This retrospective study included adults with head and neck skin cancer who underwent reconstruction between January and September 2016-2020, extracting data from the National Readmission Database. Patients who died during the index admission or had missing key information were excluded. The primary outcome was 90-day unplanned readmission. Independent predictors were identified using logistic regression analysis. Postoperative acute kidney injury (AKI), identified using International Classification of Disease (ICD) diagnosis codes, was evaluated as a secondary outcome. RESULTS: In total, 5,243 patients (mean age 72 years, 78% male) were included, representing 9,490 hospitalizations nationwide. Overall, 1,046 patients (20.0%) experienced 90-day readmission. Private or HMO insurance was associated with lower odds of readmission (aOR = 0.72, 95% CI: 0.57-0.91). Severe liver disease (aOR = 4.69, 95% CI: 1.65-13.33), sepsis (aOR = 1.93, 95% CI: 1.22-3.08), dysphagia (aOR = 1.70, 95% CI: 1.20-2.41), renal disease (aOR = 1.41, 95% CI: 1.17-1.70), and bleeding/hemorrhage (aOR = 1.44, 95% CI: 1.11-1.88) were significant factors associated with readmission. AKI occurred in 306 patients (5.8%). CONCLUSIONS: This study identified severe liver disease, sepsis, dysphagia, and renal disease as factors independently associated with increased 90-day readmission risk. AKI was not uncommon, underscoring the importance of perioperative optimization and vigilant monitoring in high-risk patients.