Audit of Patient Communications Following Transoral Robotic Surgery.

Abstract

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.