Russell C Langan1, Chun-Chih Huang2, Scott Colton3, Arnold L Potosky4, Lynt B Johnson5, Nawar M Shara6, Waddah B Al-Refaie7. 1. Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC. 2. MedStar Health Research Institute, Washington, DC. 3. Department of Surgery, Georgetown University Hospital, Washington, DC. 4. MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Lombardi Comprehensive Cancer Center, Washington, DC. 5. Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Lombardi Comprehensive Cancer Center, Washington, DC. 6. MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. 7. Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Lombardi Comprehensive Cancer Center, Washington, DC. Electronic address: Waddah.B.Al-Refaie@gunet.georgetown.edu.
Abstract
BACKGROUND: Decreasing readmissions has become a focus of emerging efforts to improve the quality and affordability of health care. However, little is known about reasons for readmissions after major cancer surgery in the expanding elderly population (≥65 years) who are also at increased risk of adverse operative events. We sought to identify (1) the extent to which older age impacts readmissions and (2) factors predictive of 30- and 90-day readmissions after major cancer surgery among older adults. METHODS: We identified 2,797 older adults who underwent 1 of 7 types of major thoracic or abdominopelvic cancer surgery within a large multihospital system from 2003 to 2012. Multivariate logistic regression analyses were conducted to identify predictors of 30- and 90-day readmission controlling for covariates. RESULTS: Overall 30- and 90-day readmission rates were 16% and 24% with the majority of readmissions occurring within 15-days of discharge. Principal diagnoses of 30-day readmissions included gastrointestinal, pulmonary, and infections complications. The 30-day readmissions were associated with >2 comorbid conditions and ≥2 postoperative complications. Readmissions varied significantly according to cancer surgery type and across treating hospitals. Readmissions did not vary by increasing age. Factors associated with 90-day readmission were comparable to those observed at 30 days. CONCLUSION: In this large, multihospital study of older adults, multiple morbidities, procedure type, greater number of complications, and the treating hospital predicted 30- and 90-day readmissions. These findings point toward the potential impact of hospital-level factors behind readmission. Our results also heighten the importance of assessing the influence of readmission on other important cancer care metrics, namely, patient-reported outcomes and the completion of adjuvant systemic therapies.
BACKGROUND: Decreasing readmissions has become a focus of emerging efforts to improve the quality and affordability of health care. However, little is known about reasons for readmissions after major cancer surgery in the expanding elderly population (≥65 years) who are also at increased risk of adverse operative events. We sought to identify (1) the extent to which older age impacts readmissions and (2) factors predictive of 30- and 90-day readmissions after major cancer surgery among older adults. METHODS: We identified 2,797 older adults who underwent 1 of 7 types of major thoracic or abdominopelvic cancer surgery within a large multihospital system from 2003 to 2012. Multivariate logistic regression analyses were conducted to identify predictors of 30- and 90-day readmission controlling for covariates. RESULTS: Overall 30- and 90-day readmission rates were 16% and 24% with the majority of readmissions occurring within 15-days of discharge. Principal diagnoses of 30-day readmissions included gastrointestinal, pulmonary, and infections complications. The 30-day readmissions were associated with >2 comorbid conditions and ≥2 postoperative complications. Readmissions varied significantly according to cancer surgery type and across treating hospitals. Readmissions did not vary by increasing age. Factors associated with 90-day readmission were comparable to those observed at 30 days. CONCLUSION: In this large, multihospital study of older adults, multiple morbidities, procedure type, greater number of complications, and the treating hospital predicted 30- and 90-day readmissions. These findings point toward the potential impact of hospital-level factors behind readmission. Our results also heighten the importance of assessing the influence of readmission on other important cancer care metrics, namely, patient-reported outcomes and the completion of adjuvant systemic therapies.
Authors: Chaoyi Zheng; Elizabeth B Habermann; Nawar M Shara; Russell C Langan; Young Hong; Lynt B Johnson; Waddah B Al-Refaie Journal: J Am Coll Surg Date: 2016-02-05 Impact factor: 6.113
Authors: Young Hong; Chaoyi Zheng; Elizabeth Hechenbleikner; Lynt B Johnson; Nawar Shara; Waddah B Al-Refaie Journal: J Am Coll Surg Date: 2016-05-31 Impact factor: 6.113
Authors: Jegy M Tennison; Nahid J Rianon; Joanna G Manzano; Mark F Munsell; Marina C George; Eduardo Bruera Journal: Cancer Med Date: 2021-07-27 Impact factor: 4.452