Infection prolongs length of hospital stay after head and neck cancer

Researchers at the Registry have shown that infection is a significant complication after surgery for head and neck cancer. As in other countries, complex invasive surgery leads to longer hospital stay in Irish hospitals where recovery is frequently hampered by infection.

The role of the surgeon in head and neck cancer (HNC) treatment has evolved over the last two decades to include much more salvage surgery, and complex reconstruction work. Hospital length of stay (LOS) after surgery is a major contributor to the overall cost of care. Researchers at the National Cancer Registry Ireland (NCRI) carried out a population-based study of sociodemographic, clinical, and health service factors affecting length of stay (LOS) after treatment for head and neck cancer.

Patients who underwent HNC surgery (e.g. excision/destruction procedure on the mouth, pharynx, larynx) were identified in the linked registry-hospital inpatient enquiry (HIPE) dataset (2002-2010). LOS was measured from the date of the surgery to the date of discharge or death in hospital.

The median LOS was 10 days (range 1-289). Extensive HNC surgery with reconstruction was associated with greater risk of infection. Of the patients in the dataset, 14% acquired an infection after surgery. LOS was 26 days longer in the subset that developed postoperative infection. The longer LOS probably reflected efforts to control the infection in these patients. A quarter of the patients in our dataset required a tracheostomy (a tube which is inserted into the trachea to assist breathing); these individuals had significantly prolonged LOS (median 30 days with tracheostomy versus 7 days, without tracheostomy). They were also almost 4 times more prone to any infection, particularly pneumonia.

Tracheostomy and hospital acquired infections are two potentially modifiable risk factors which were shown to greatly prolong LOS. Measures to reduce postoperative infection by implementing and enforcing infection control in hospitals should reduce LOS and, consequently, health service costs.

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