Association of a perioperative education program with unplanned readmission following total laryngectomy

IMPORTANCE Patients undergoing total laryngectomy (TL) are at high risk for 30-day hospital readmission. Strategies to decrease the readmission rate remain unknown. OBJECTIVES To assess the association of a comprehensive perioperative TL education program with unplanned readmissions; to determine the program's association with the rate of readmissions for stomal or tracheoesophageal puncture (TEP) complications and patient and caregiver knowledge of and preparedness for TL. DESIGN, SETTING, AND PARTICIPANTS This single-institution prospective pilot studywas conducted between December 1, 2014, and November 30, 2016, among 50 patients undergoing a perioperative TL education program at a tertiary care academic medical center. INTERVENTION The perioperative TL education program consisted of speech-language pathology counseling, a hands-on class with an otolaryngology nurse educator, a TL "Journal Guide" booklet, and a prehospital discharge competency assessment. A family member or friend acting as a laryngectomy coach accompanied patients throughout. MAIN OUTCOMES AND MEASURES The primary outcomewas the rate of 30-day unplanned readmission. Secondary measures included the rate of readmission for stomal or TEP complications and change in knowledge of and preparedness for TL. RESULTS Of the 50 patients (12 women and 38 men; median age, 61 years [range, 47-86 years]) who underwent the TL education program, the 30-day unplanned readmission rate was 20% (n=10). Only 1 patient (2%) had a readmission for a stomal or TEP complication. Patients increased their TL knowledge (median improvement in TL knowledge test score, 3.5 [95%CI, 2.8-4.2] of 12) and preparedness (median improvement in TL preparedness score, 3.1 [95%CI, 2.4-3.8] of 10) after undergoing the intervention. CONCLUSIONS AND RELEVANCE This prospective pilot study evaluated an intervention to decrease unplanned readmission in head and neck oncology patients. It provides data indicating that a comprehensive perioperative TL education program is feasible. This program has the potential to decrease 30-day readmission for stomal or TEP complications and merits further study in a larger, multicenter clinical trial.