Readmissions after complex cancer surgery: Analysis of the nationwide readmissions database

Syed Nabeel Zafar, Adil A. Shah, Christine Nembhard, Lori L. Wilson, Elizabeth B Habermann, Mustafa Raoof, Nabil Wasif

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose Hospital readmissions after surgery are a focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs).We aim to describe the burden, timing, and factors associated with readmissions after complex cancer surgery. Methods The Nationwide Readmissions Database (2013) was used to select patients undergoing a complex oncologic resection, which was defined as esophagectomy/gastrectomy, hepatectomy, pancreatectomy, colorectal resection, lung resection, or cystectomy. Readmissions within 30 days from discharge were analyzed. International Classification of Diseases (9th revision) primary diagnosis codes were reviewed to identify PPRs. Multivariable logistic regression analyses identified demographic, clinical, and hospital factors associated with readmissions. Results Of the 59,493 eligible patients, 14% experienced a 30-day readmission, and 82% of these were deemed PPRs. Half of the readmissions occurred within the first 8 days of discharge. Infections (26%), GI complications (17%), and respiratory conditions (10%) accounted for most readmissions. Factors independently associated with an increased likelihood of readmission included Medicaid versus private insurance (odds ratio [OR], 1.32; 95% CI, 1.17 to 1.48), higher comorbidity score (OR, 1.5;95%CI, 1.33 to 1.63), discharge to a facility (OR, 1.39; 95% CI, 1.29 to 1.51), prolonged length of stay (OR, 1.42; 95% CI, 1.32 to 1.52), and occurrence of a major in-hospital complication (OR, 1.24; 95% CI, 1.16 to 1.34). Conclusion One in seven patients undergoing complex cancer surgery suffered a readmission within 30 days.Weidentified common causes of these and identified patients at high risk for such an event. These data can be used by physicians, administrators, and policymakers to develop strategies to decrease readmissions.

Original languageEnglish (US)
Pages (from-to)e335-e345
JournalJournal of Oncology Practice
Volume14
Issue number6
DOIs
StatePublished - Jun 1 2018

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Odds Ratio
Databases
Neoplasms
Patient Readmission
Pancreatectomy
Esophagectomy
Cystectomy
Medicaid
Hepatectomy
International Classification of Diseases
Gastrectomy
Quality Improvement
Insurance
Administrative Personnel
Comorbidity
Length of Stay
Logistic Models
Regression Analysis
Demography
Physicians

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Readmissions after complex cancer surgery : Analysis of the nationwide readmissions database. / Zafar, Syed Nabeel; Shah, Adil A.; Nembhard, Christine; Wilson, Lori L.; Habermann, Elizabeth B; Raoof, Mustafa; Wasif, Nabil.

In: Journal of Oncology Practice, Vol. 14, No. 6, 01.06.2018, p. e335-e345.

Research output: Contribution to journalArticle

Zafar, Syed Nabeel ; Shah, Adil A. ; Nembhard, Christine ; Wilson, Lori L. ; Habermann, Elizabeth B ; Raoof, Mustafa ; Wasif, Nabil. / Readmissions after complex cancer surgery : Analysis of the nationwide readmissions database. In: Journal of Oncology Practice. 2018 ; Vol. 14, No. 6. pp. e335-e345.
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abstract = "Purpose Hospital readmissions after surgery are a focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs).We aim to describe the burden, timing, and factors associated with readmissions after complex cancer surgery. Methods The Nationwide Readmissions Database (2013) was used to select patients undergoing a complex oncologic resection, which was defined as esophagectomy/gastrectomy, hepatectomy, pancreatectomy, colorectal resection, lung resection, or cystectomy. Readmissions within 30 days from discharge were analyzed. International Classification of Diseases (9th revision) primary diagnosis codes were reviewed to identify PPRs. Multivariable logistic regression analyses identified demographic, clinical, and hospital factors associated with readmissions. Results Of the 59,493 eligible patients, 14{\%} experienced a 30-day readmission, and 82{\%} of these were deemed PPRs. Half of the readmissions occurred within the first 8 days of discharge. Infections (26{\%}), GI complications (17{\%}), and respiratory conditions (10{\%}) accounted for most readmissions. Factors independently associated with an increased likelihood of readmission included Medicaid versus private insurance (odds ratio [OR], 1.32; 95{\%} CI, 1.17 to 1.48), higher comorbidity score (OR, 1.5;95{\%}CI, 1.33 to 1.63), discharge to a facility (OR, 1.39; 95{\%} CI, 1.29 to 1.51), prolonged length of stay (OR, 1.42; 95{\%} CI, 1.32 to 1.52), and occurrence of a major in-hospital complication (OR, 1.24; 95{\%} CI, 1.16 to 1.34). Conclusion One in seven patients undergoing complex cancer surgery suffered a readmission within 30 days.Weidentified common causes of these and identified patients at high risk for such an event. These data can be used by physicians, administrators, and policymakers to develop strategies to decrease readmissions.",
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AU - Wasif, Nabil

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N2 - Purpose Hospital readmissions after surgery are a focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs).We aim to describe the burden, timing, and factors associated with readmissions after complex cancer surgery. Methods The Nationwide Readmissions Database (2013) was used to select patients undergoing a complex oncologic resection, which was defined as esophagectomy/gastrectomy, hepatectomy, pancreatectomy, colorectal resection, lung resection, or cystectomy. Readmissions within 30 days from discharge were analyzed. International Classification of Diseases (9th revision) primary diagnosis codes were reviewed to identify PPRs. Multivariable logistic regression analyses identified demographic, clinical, and hospital factors associated with readmissions. Results Of the 59,493 eligible patients, 14% experienced a 30-day readmission, and 82% of these were deemed PPRs. Half of the readmissions occurred within the first 8 days of discharge. Infections (26%), GI complications (17%), and respiratory conditions (10%) accounted for most readmissions. Factors independently associated with an increased likelihood of readmission included Medicaid versus private insurance (odds ratio [OR], 1.32; 95% CI, 1.17 to 1.48), higher comorbidity score (OR, 1.5;95%CI, 1.33 to 1.63), discharge to a facility (OR, 1.39; 95% CI, 1.29 to 1.51), prolonged length of stay (OR, 1.42; 95% CI, 1.32 to 1.52), and occurrence of a major in-hospital complication (OR, 1.24; 95% CI, 1.16 to 1.34). Conclusion One in seven patients undergoing complex cancer surgery suffered a readmission within 30 days.Weidentified common causes of these and identified patients at high risk for such an event. These data can be used by physicians, administrators, and policymakers to develop strategies to decrease readmissions.

AB - Purpose Hospital readmissions after surgery are a focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs).We aim to describe the burden, timing, and factors associated with readmissions after complex cancer surgery. Methods The Nationwide Readmissions Database (2013) was used to select patients undergoing a complex oncologic resection, which was defined as esophagectomy/gastrectomy, hepatectomy, pancreatectomy, colorectal resection, lung resection, or cystectomy. Readmissions within 30 days from discharge were analyzed. International Classification of Diseases (9th revision) primary diagnosis codes were reviewed to identify PPRs. Multivariable logistic regression analyses identified demographic, clinical, and hospital factors associated with readmissions. Results Of the 59,493 eligible patients, 14% experienced a 30-day readmission, and 82% of these were deemed PPRs. Half of the readmissions occurred within the first 8 days of discharge. Infections (26%), GI complications (17%), and respiratory conditions (10%) accounted for most readmissions. Factors independently associated with an increased likelihood of readmission included Medicaid versus private insurance (odds ratio [OR], 1.32; 95% CI, 1.17 to 1.48), higher comorbidity score (OR, 1.5;95%CI, 1.33 to 1.63), discharge to a facility (OR, 1.39; 95% CI, 1.29 to 1.51), prolonged length of stay (OR, 1.42; 95% CI, 1.32 to 1.52), and occurrence of a major in-hospital complication (OR, 1.24; 95% CI, 1.16 to 1.34). Conclusion One in seven patients undergoing complex cancer surgery suffered a readmission within 30 days.Weidentified common causes of these and identified patients at high risk for such an event. These data can be used by physicians, administrators, and policymakers to develop strategies to decrease readmissions.

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