Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Anecdotally, there is frequent communication between patients and providers following transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). A better understanding of the patterns and types of postoperative communication may allow providers to prevent patient complications and readmission. Thus, the objective of this study was to assess frequency and reasons for postoperative communication, ED visits, and hospital readmission following TORS for OPSCC.
Methods: A retrospective chart review was conducted of patients who underwent TORS for OPSCC from July 2014 to October 2021. Documentation of communication between patients and providers via phone call or message within 30 days postoperatively was recorded. 30-day hospital re-presentation was defined as any emergency department visit and/or hospital readmission within 30-days postoperatively.
Results: A total of 100 patients who underwent TORS for OPSCC were included (81% male, 96% Caucasian, 61.2 ± 9.33 years old). 57% were smokers. Average T category was 1.38 ± 0.70 and N category was 0.93 ± 0.65. Average time to first postoperative clinic visit was 7.88 ± 4.29 days. On average, each patient communicated via phone or message 3.12 ± 2.46 times within 30 days postoperatively. Of 315 total communications, the most common reason was a logistical question regarding referrals, appointments, work forms, or insurance (27.3%), followed by medication questions or refills (19.4%), and post-operative check ins from the office (16.2%). Of the 103 communications (32.7%) regarding a specific complaint, the most common complaint was pain (37.8%) followed by dysphagia (21.6%), and then surgical drain issues (12.6%). Overall, 22 patients (22%) re-presented a total of 27 times within 30 days postoperatively. Of the 27 re-presentations, 12 (44%) were predated by relevant communication, though communication did not remain predictive on univariate logistic regression (P=0.13). The most common reason for re-presentation was oropharyngeal bleed (n=10, 37%), followed by dysphagia (n=4, 14.8%). Of the 10 re-presentations for bleed, only 2 were predated by a relevant patient-to-provider communication. Conversely, of 6 communications regarding bleed, only 2 resulted in hospital re-presentation.
Conclusion: Patient-to-provider communication following TORS for OPSCC offers insight into postoperative complications that may not result in hospital presentation, highlighting areas for improved medical discharge planning or inpatient education. Moreover, hospital re-presentation was often predated by a phone call or message, which may suggest a role of patient communication in predicting readmission. Bleeding, however, was not frequently predated by communications, despite being the most frequent reason for postoperative re-presentation.