Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Socioeconomic factors have been shown to influence outcomes following head and neck free flap reconstruction. Area deprivation index (ADI) is a validated percentile rank of socioeconomic disadvantage determined at the census block. The objective of the current study was to examine the association between ADI and total laryngectomy outcomes.
Methods: A single institution retrospective chart review was performed of patients who underwent total laryngectomy with free flap reconstruction between 2016 and 2020. Each patient’s address was geocoded to their census block group and linked to national ADI ranks (percentiles) were retrospectively assigned to patients. ADIs were analyzed as both continuous and categorical (quartiles) variables. Higher ADI scores and higher quartiles represented the more deprived areas. Outcomes included age, gender, body mass index, gastrostomy tube dependence, need for preoperative gastrostomy tube, medical comorbidities, Clavien-Dindo complications while hospitalized, cancer stage, prior treatment, length of stay, disposition to home (vs nursing facility), 30-day emergency department (ED) visits, and 30-day hospital readmission.
Results: A total of 98 patients (60.5 ± 8.8 years old) who underwent total laryngectomy with free flap reconstruction were included. 24 patients (24.5%) were readmitted within 30 days. When examined as a continuous variable, ADI was not predictive of outcomes (all P>0.05). When separated into quartiles, most patients fell into the highest/most deprived (fourth) quartile of deprivation (n=47, 48%), followed by the third quartile (n=34, 34.7%). Interestingly, lower (less deprived) ADI quartile was predictive of higher 30-day hospital readmission on univariate logistic regression (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.12-4.17, P=.021), though not associated with emergency department utilization (P>0.05). Specifically, 11.1% of patients in the fourth quartile were readmitted, compared to 34.1% in the first through third quartiles (P=0.009). The rate of discharge home was similar (Q4 vs. Q1-3, 63.6% vs. 68.9%, P>0.05). Lower ADI remained predictive of 30-day readmission on multivariable logistic regression when controlling for age, discharge home, cancer stage, and prior radiation (OR 5.84, 95% CI 1.55-22.22, P=0.009).
Conclusion: In our cohort, patients of higher socioeconomic status patients had a significantly higher rate of 30-day readmission following total laryngectomy with free flap reconstruction. This may reflect increased utilization of the direct readmission workflow by patients with better resources and health literacy. Patients in deprived areas may rely more on local hospital systems, which may not be evidenced in our medical record review. Further analysis is needed to determine how neighborhood and individual-level socioeconomic status affects total laryngectomy outcomes.