TY - JOUR
T1 - Fragmentation of Care after Surgical Discharge
T2 - Non-Index Readmission after Major Cancer Surgery
AU - Zheng, Chaoyi
AU - Habermann, Elizabeth B.
AU - Shara, Nawar M.
AU - Langan, Russell C.
AU - Hong, Young
AU - Johnson, Lynt B.
AU - Al-Refaie, Waddah B.
N1 - Publisher Copyright:
© 2016 American College of Surgeons.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84962502475&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84962502475&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2016.01.052
DO - 10.1016/j.jamcollsurg.2016.01.052
M3 - Article
C2 - 27016905
AN - SCOPUS:84962502475
SN - 1072-7515
VL - 222
SP - 780-789.e2
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 5
ER -