Inferior outcomes associated with emergency department presentation for head and neck cancer surgery☆

Purpose: Head and neck cancer (HNC) patients frequently require care through emergency departments (ED) due to lack of access or symptom acuity, however, the frequency and implications of this occurrence have not been delineated. Objective: To determine the association between emergency department admission of HNC surgery with length of stay (LOS) and total costs (TC). Methods: A cohort of 12,920 adult HNC patients admitted to acute care hospitals receiving ablative surgery during index admission was identified using the New York State Inpatient Database from 2006 to 2016. Outcomes included LOS, TC, 90-day complications, and inpatient mortality. Results: Eight percent of the cohort was admitted through the ED, which increased over the study period from 6.52% (95% CI: 5.05–7.99) to 17.0% (95% CI: 14.9–19.1). ED admission was associated with a longer LOS (11 days longer, 95% CI 10.3–11.7) and higher mean TC ($43,197) versus non-ED admission ($19,010), with a mean difference of $24,191 (95% CI 20,713–27,669). After controlling for covariates, ED admission was associated with an 81.6% (95% CI 76.8–86.5) and 80.4% (95% CI 70.5–90.8) increase in LOS and TC, respectively, and decreased survival with a hazard ratio of 1.97 (95% CI 1.60–2.42). Conclusions: Rates of ED admission for HNC diagnoses requiring surgical intervention during index admission are rising and associated with longer LOS higher TC, more postoperative complications, and increased inpatient mortality after accounting for patient and facility differences. Striving for high-quality HNC cancer care demands addressing barriers to care that contribute to patients relying on the ED for access.