Association of Safety-Net Hospital Status With Outcomes Following Head and Neck Cancer Operations

Josef Madrigal; Laith Mukdad; Arjun Verma; Peyman Benharash; Maie A St John

doi:10.1002/ohn.796

Association of Safety-Net Hospital Status With Outcomes Following Head and Neck Cancer Operations

Otolaryngol Head Neck Surg. 2024 May 8. doi: 10.1002/ohn.796. Online ahead of print.

Authors

Josef Madrigal^{1

2}, Laith Mukdad¹, Arjun Verma², Peyman Benharash², Maie A St John¹

Affiliations

¹ Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
² Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.

PMID: 38716773
DOI: 10.1002/ohn.796

Abstract

Objective: To assess perioperative and readmission outcomes of patients undergoing head and neck cancer (HNCA) surgery at safety-net hospitals (SNHs) in a modern cohort.

Study design: Retrospective cohort study.

Setting: Nationwide Readmissions Database (NRD), 2010 to 2019.

Methods: All elective adult (≥18 years) admissions involving HNCA resection were identified from the NRD. To calculate safety-net burden, the proportion of Medicaid or uninsured patients admitted to each hospital for any indication was tabulated annually, with centers in the highest quartile defined as SNHs. To perform risk adjustment in assessing perioperative and readmission outcomes, multivariable regression models were developed.

Results: Of an estimated 133,018 head and neck surgical patients, 26.5% (n = 35,268) received treatment at a SNH. Utilization of SNHs increased over the decade-long study period, with 29.8% of individuals treated at these sites in 2019. After multivariable adjustment, several patient factors were noted to be associated with SNHs, including younger age, lower comorbidity burden, and income within the lowest quartile. Although incidence of adverse events decreased at both SNHs and non-SNHs during the study period, treatment at SNHs remained associated with these events after risk adjustment (adjusted odds ratio: 1.17, 95% confidence interval: 1.08-1.28, P < .001).

Conclusion: SNHs continue to provide valuable specialty care to underserved populations, often with limited financial resources. Despite promising results from prior decades demonstrating comparable perioperative outcomes, the present study noted increased adverse events following HNCA surgery at these sites. Such findings underscore the need for continued advocacy to secure necessary funding for these centers.

Keywords: head and neck cancer; health care disparities; outcomes research; safety‐net hospitals.