Shitanshu Uppal1, Courtney Penn2, Marcela G Del Carmen3, J Alejandro Rauh-Hain3, R Kevin Reynolds2, Laurel W Rice4. 1. Division of Gynecologic Oncology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, United States. Electronic address: uppal@med.umich.edu. 2. Division of Gynecologic Oncology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States. 3. Division of Gynecologic Oncology, Vincent Program in Global Obstetrics & Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, United States. 4. Division of Gynecologic Oncology, University of Wisconsin, 600 Highland Ave., Madison, WI 53792, United States.
Abstract
OBJECTIVES: To examine the underlying indications, timing, and risk factors associated with unplanned hospital readmissions after major surgery for a gynecologic malignancy. METHODS: This is a retrospective database cohort study utilizing the National Surgical Quality Improvement Program database (NSQIP). The association between risk factors with respect to 30-day unplanned readmission was modeled using logistic regression. Timing of readmission and the primary reason of readmission was abstracted from the database. RESULTS: Overall, the unplanned readmission rate was 6.5% (832/12,804). On multivariate analysis, operative time≥3h (OR 1.39, p<0.001), open abdominal surgery (OR 2.2, p<0.001), any complication prior to discharge (OR 1.6, p<0.001), two or more additional surgical procedures (OR 1.34, p=0.003), or cervical cancer as the site of primary disease (OR 1.30, p=0.05) were noted to be independent predictors of readmission. To provide a convenient calculation of overall probability of readmission, we developed a nomogram of factors significantly predicting readmission. Overall, infections were a cause of 45% of the readmissions. Surgical Site Infections were the most common reason, accounting for 29.2% of all readmissions. A majority of the readmissions (approximately 75%) were within two weeks of discharge from the hospital. CONCLUSIONS: Efforts to reduce readmission rates should focus on identifying patients at a high risk of readmission and reducing surgical site infections. Additionally, prospective evaluation of interventions targeted at reducing readmissions should focus on the first two weeks after discharge from the hospital.
OBJECTIVES: To examine the underlying indications, timing, and risk factors associated with unplanned hospital readmissions after major surgery for a gynecologic malignancy. METHODS: This is a retrospective database cohort study utilizing the National Surgical Quality Improvement Program database (NSQIP). The association between risk factors with respect to 30-day unplanned readmission was modeled using logistic regression. Timing of readmission and the primary reason of readmission was abstracted from the database. RESULTS: Overall, the unplanned readmission rate was 6.5% (832/12,804). On multivariate analysis, operative time≥3h (OR 1.39, p<0.001), open abdominal surgery (OR 2.2, p<0.001), any complication prior to discharge (OR 1.6, p<0.001), two or more additional surgical procedures (OR 1.34, p=0.003), or cervical cancer as the site of primary disease (OR 1.30, p=0.05) were noted to be independent predictors of readmission. To provide a convenient calculation of overall probability of readmission, we developed a nomogram of factors significantly predicting readmission. Overall, infections were a cause of 45% of the readmissions. Surgical Site Infections were the most common reason, accounting for 29.2% of all readmissions. A majority of the readmissions (approximately 75%) were within two weeks of discharge from the hospital. CONCLUSIONS: Efforts to reduce readmission rates should focus on identifying patients at a high risk of readmission and reducing surgical site infections. Additionally, prospective evaluation of interventions targeted at reducing readmissions should focus on the first two weeks after discharge from the hospital.
Authors: Margaret I Liang; Emeline M Aviki; Jason D Wright; Laura J Havrilesky; Leslie R Boyd; Haley A Moss; Elizabeth L Jewell; David E Cohn; Sachin M Apte; Patrick F Timmins; Ronald D Alvarez; Jill Rathbun; Elizabeth Lipinski; Susan White; Dorimar Siverio-Minardi; Emily M Ko Journal: Gynecol Oncol Date: 2020-01-06 Impact factor: 5.482