Audit of Patient Communications Following Transoral Robotic Surgery
Jonathan Goulazian, Micah K. Harris, Kelly Daniels, Matthew E. Spector, Kevin J. Contrera, Joshua D. Smith, Seungwon Kim, Steven B. Chinn, Jessica Maxwell, Shaum S. SridharanABSTRACT
Objective
To characterize patient‐initiated communications after transoral robotic surgery (TORS) for human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) and assess associations with 30‐day emergency department (ED) presentation and hospital readmission.
Methods
Retrospective review of adults undergoing TORS at a single tertiary center (July 2014–October 2021). Patient demographics, tumor characteristics, postoperative outcomes, and communications within 30 days were assessed. Logistic regression assessed associations with 30‐day ED presentation or readmission.
Results
Among 249 patients (85.1% male; mean age 60.1 ± 9.9 years), 179 patients (71.8%) initiated communications, for a total of 448 individual communications (2.5 ± 1.8 per patient). Non‐medical concerns accounted for 58.0%, with medical concerns accounting for 42.0%. Fifty‐seven patients (22.9%) presented to the ED within 30 days; patients with ≥ 1 communication had higher ED presentation rates (27.9% vs. 10.0%, p = 0.002). On multivariate logistic regression, ≥ 1 communication (OR 2.98, 95% CI 1.12–7.87, p = 0.03) and longer duration from discharge to first postoperative appointment (OR 1.09, 95% CI 1.01–1.17, p = 0.03) remained significantly associated with 30‐day ED presentation. Notably, triaging providers recommended hospital presentation for only 16.0% of medical complaints.
Conclusions
Patient‐initiated communications following TORS are common and mostly for logistical reasons. Communication frequency and time to first postoperative visit were predictive of 30‐day ED presentation, suggesting that adjusting time to first postoperative appointment, enhanced discharge education, and early postoperative check‐ins may be tangible methods to reduce unplanned healthcare utilization.