Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery

Chaoyi Zheng, Elizabeth B Habermann, Nawar M. Shara, Russell C. Langan, Young Hong, Lynt B. Johnson, Waddah B. Al-Refaie

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Despite national emphasis on care coordination, little is known about how fragmentation affects cancer surgery outcomes. Our study examines a specific form of fragmentation in post-discharge care-readmission to a hospital different from the location of the operation-and evaluates its causes and consequences among patients readmitted after major cancer surgery. Study Design: We used the State Inpatient Database of California (2004 to 2011) to identify patients who had major cancer surgery and their subsequent readmissions. Logistic models were used to examine correlates of non-index readmissions and to assess associations between location of readmission and outcomes, measured by in-hospital mortality and repeated readmission. Results: Of 9,233 readmissions within 30 days of discharge after major cancer surgery, 20.0% occurred in non-index hospitals. Non-index readmissions were associated with emergency readmission (odds ratio [OR] = 2.63; 95% CI, 2.26-3.06), rural residence (OR = 1.81; 95% CI, 1.61-2.04), and extensive procedures (eg, hepatectomy vs proctectomy; OR = 2.77; CI, 2.08-3.70). Mortality was higher during non-index readmissions than index readmissions independent of patient, procedure, and hospital factors (OR = 1.31; 95% CI, 1.03-1.66), but was mitigated by adjusting for conditions present at readmission (OR = 1.24; 95% CI, 0.98-1.58). Non-index readmission predicted higher odds of repeated readmission within 60 days of discharge from the first readmission (OR = 1.16; 95% CI, 1.02-1.32), independent of all covariates. Conclusions: Non-index readmissions constitute a substantial proportion of all readmissions after major cancer surgery. They are associated with more repeated readmissions and can be caused by severe surgical complications and increased travel burden. Overcoming disadvantages of non-index readmissions represents an opportunity to improve outcomes for patients having major cancer surgery.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
DOIs
StateAccepted/In press - Oct 20 2015

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Odds Ratio
Neoplasms
Patient Readmission
Hepatectomy
Hospital Mortality
Inpatients
Emergencies
Logistic Models
Databases
Mortality

ASJC Scopus subject areas

  • Surgery

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Fragmentation of Care after Surgical Discharge : Non-Index Readmission after Major Cancer Surgery. / Zheng, Chaoyi; Habermann, Elizabeth B; Shara, Nawar M.; Langan, Russell C.; Hong, Young; Johnson, Lynt B.; Al-Refaie, Waddah B.

In: Journal of the American College of Surgeons, 20.10.2015.

Research output: Contribution to journalArticle

Zheng, Chaoyi ; Habermann, Elizabeth B ; Shara, Nawar M. ; Langan, Russell C. ; Hong, Young ; Johnson, Lynt B. ; Al-Refaie, Waddah B. / Fragmentation of Care after Surgical Discharge : Non-Index Readmission after Major Cancer Surgery. In: Journal of the American College of Surgeons. 2015.
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abstract = "Background: Despite national emphasis on care coordination, little is known about how fragmentation affects cancer surgery outcomes. Our study examines a specific form of fragmentation in post-discharge care-readmission to a hospital different from the location of the operation-and evaluates its causes and consequences among patients readmitted after major cancer surgery. Study Design: We used the State Inpatient Database of California (2004 to 2011) to identify patients who had major cancer surgery and their subsequent readmissions. Logistic models were used to examine correlates of non-index readmissions and to assess associations between location of readmission and outcomes, measured by in-hospital mortality and repeated readmission. Results: Of 9,233 readmissions within 30 days of discharge after major cancer surgery, 20.0{\%} occurred in non-index hospitals. Non-index readmissions were associated with emergency readmission (odds ratio [OR] = 2.63; 95{\%} CI, 2.26-3.06), rural residence (OR = 1.81; 95{\%} CI, 1.61-2.04), and extensive procedures (eg, hepatectomy vs proctectomy; OR = 2.77; CI, 2.08-3.70). Mortality was higher during non-index readmissions than index readmissions independent of patient, procedure, and hospital factors (OR = 1.31; 95{\%} CI, 1.03-1.66), but was mitigated by adjusting for conditions present at readmission (OR = 1.24; 95{\%} CI, 0.98-1.58). Non-index readmission predicted higher odds of repeated readmission within 60 days of discharge from the first readmission (OR = 1.16; 95{\%} CI, 1.02-1.32), independent of all covariates. Conclusions: Non-index readmissions constitute a substantial proportion of all readmissions after major cancer surgery. They are associated with more repeated readmissions and can be caused by severe surgical complications and increased travel burden. Overcoming disadvantages of non-index readmissions represents an opportunity to improve outcomes for patients having major cancer surgery.",
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AU - Johnson, Lynt B.

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