Abstract
Background
The burden of readmissions after major cancer surgery is high. Prior work suggests that one-third of readmitted patients are readmitted to a different hospital than where the surgery was performed. The impact of this location of readmission needs to be more thoroughly understood.
Methods
This retrospective cohort study was performed on Surveillance, Epidemiology, and End Results (SEER)-Medicare patients with bladder, esophagus, lung, or pancreas cancer diagnosed from 2001 to 2007 who underwent extirpative surgery and were readmitted within 90 days. Readmission location was classified as ‘index’ if readmission was at the hospital where surgery was performed, or ‘different’ if readmission was elsewhere. Outcomes including complications, reoperations, in-hospital mortality, 90-day mortality, and 90-day total costs were compared based on the location of readmission using a propensity score inverse probability treatment weight analysis.
Results
Overall, 7903 (28 %) patients were readmitted within 90 days of index hospitalization. Thirty-three percent were readmitted to a different hospital (bladder 30 %, esophagus 34 %, lung 34 %, pancreas 34 %). Ninety-day mortality and total costs of care were not significantly different between the readmission location groups (all p > 0.05); however, substantial differences in the types of patients, and timing of and reasons for readmission were observed between the two groups.
Conclusions
Patients readmitted to different hospitals after major cancer surgery are a different group of patients than those readmitted to the index hospital. Accounting for this, we did not find significant differences in short-term clinical outcomes or costs of care based on readmission location; however, differences in long-term outcomes were observed that should be further explored in future studies.
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Funding
Work on this study was supported by the Integrated Cancer Information and Surveillance System (ICISS), University of North Carolina Lineberger Comprehensive Cancer Center, with funding provided by the University Cancer Research Fund (UCRF) via the state of North Carolina. Dr. Nielsen is supported in part by the National Institutes of Health (grant number 1R21CA191610-01), the American Cancer Society (grant MRSG-13-154-01-CPPB), and the Urology Care Foundation/Astellas (Rising Stars in Urology Research Award). The funders did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Conflicts of interest
Karyn B. Stitzenberg, YunKyung Chang, Angela B. Smith, Michael O. Meyers, and Matthew E. Nielsen have no relevant conflicts of interest to report.
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I, Karyn Stitzenberg, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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Stitzenberg, K.B., Chang, Y., Smith, A.B. et al. Impact of Location of Readmission on Outcomes After Major Cancer Surgery. Ann Surg Oncol 24, 319–329 (2017). https://doi.org/10.1245/s10434-016-5528-1
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DOI: https://doi.org/10.1245/s10434-016-5528-1