Comparison of Rates and Outcomes of Readmission to Index vs Nonindex Hospitals After Major Cancer Surgery

Zafar, Syed Nabeel; Shah, Adil A.; Channa, Hira; Raoof, Mustafa; Wilson, Lori; Wasif, Nabil

doi:10.1001/jamasurg.2018.0380

Cited by 66 publications

(43 citation statements)

References 27 publications

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“…10,[16][17][18][19][20] Our readmission rates are also comparable to those of major cancer surgeries (eg esophagectomy, gastrectomy, hepatic or pancreatic resection, lung resection, colectomy, cystectomy), found in multiple retrospective studies. [21][22][23][24] Similar to many of these studies, among women with high-grade serous ovarian cancer, while the mortality rate in our paper was 1.7%. 25 While there is a difference between these values, it is likely secondary to the variability in information available in this database, and these results do not impact the conclusions of our study.…”

Section: Predictors Of 30-and 90-day Readmissionsupporting

confidence: 83%

Readmissions after ovarian cancer cytoreduction surgery: The first 30 days and beyond

Mardock

Rudasill

Lai

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Postoperative readmissions are often used to assess quality of surgical care. This study compared 30-day vs 31-to 90-day readmission following surgery for ovarian, fallopian tube, or primary peritoneal cancer. Methods: This retrospective study of the 2010-2015 Nationwide Readmissions Database characterized 90-day readmissions following cytoreductive surgery for these cancers. Each patient's first postoperative hospitalization was included. Univariate analysis compared patient demographics and reasons for readmission. Multivariable regression identified independent predictors of readmission. Results: Of an estimated 76 652 patients, 10 264 (13.4%) were readmitted within 30 days, and 6942 (9.1%) between 31 and 90 days. The 30-day readmissions were more frequently associated with postoperative infection, while 31-to 90-day readmissions were more frequently associated with renal or hematologic diagnoses.

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Section: Predictors Of 30-and 90-day Readmissionsupporting

confidence: 83%

Readmissions after ovarian cancer cytoreduction surgery: The first 30 days and beyond

Mardock

Rudasill

Lai

et al. 2020

Journal of Surgical Oncology

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“…Studies examining other disease states and procedures have identified fragmentation of care as an important factor affecting patient outcomes. These reports conclude that readmission to a non-index hospital results in higher rates of morbidity and mortality 13–18. Our results, however, do not follow this pattern.…”

Section: Discussioncontrasting

confidence: 68%

“…There is limited information on whether functional outcomes after discharge vary according to readmission destination. Taking appropriate measures to prevent complications in patients undergoing mechanical thrombectomy and managing complications when they arise are essential for an effective continuum of stroke care 13…”

Section: Introductionmentioning

confidence: 99%

Frequency, predictors, and outcomes of readmission to index versus non-index hospitals after mechanical thrombectomy in patients with ischemic stroke

Shkirkova

Connor

Lamorie‐Foote

et al. 2019

J NeuroIntervent Surg

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BackgroundStroke systems of care employ a hub-and-spoke model, with fewer centers performing mechanical thrombectomy (MT) compared with stroke-receiving centers, where a higher number offer high-level, centralized treatment to a large number of patients.ObjectiveTo characterize rates and outcomes of readmission to index and non-index hospitals for patients with ischemic stroke who underwent MT.MethodsThis study leveraged a population-based, nationally representative sample of patients with stroke undergoing MT from the Nationwide Readmissions Database between 2010 and 2014. Descriptive, logistic regression analyses, and univariate and multivariate logistic regression models were carried out to determine patient- and hospital-level factors, mortality, complications, and subsequent readmissions associated with index and non-index hospitals' 90-day readmissions.ResultsIn the study, 2111 patients with a stroke were treated with MT, of whom 534 were readmitted within 90 days. The most common reasons for readmission were: septicemia (5.9%), atrial fibrillation (4.8%), and cerebral artery occlusion with infarct (4.8%). Among readmitted patients, 387 (74%) were readmitted to index and 136 (26%) to non-index hospitals. On multivariable logistic regression analysis, non-index hospital readmission was not independently associated with major complications (p=0.09), mortality (p=0.34), neurological complications (p=0.47), or second readmission (p=0.92).ConclusionOne-quarter of patients with a stroke treated with MT were readmitted within 90 days, and one quarter of these patients were readmitted to non-index hospitals. Readmission to a non-index hospital was not associated with mortality or increased complication rates. In a hub-and-spoke model it is important that follow-up care for a specialized procedure can be performed effectively at a vast number of non-index hospitals covering a large geographic area.

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“…These patients often require early stabilization, and moving to the nearest hospital may be the most appropriate measure in this situation. 19 As a result, healthcare workers will face the challenge of deciding whether to divert patients to the nearest emergency department of a different hospital or to the index hospital. A study based on the Danish population reported that low socioeconomic status was associated with higher risk of bacteremia and increased mortality, compared to high socioeconomic status.…”

Section: Discussionmentioning

confidence: 99%

Readmission to a Different Hospital and Worse Outcomes Following Sepsis: A Nationwide Cohort Study

Lin¹,

Han²,

Xu³

et al. 2020

Preprint

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BackgroundIn the United States (U.S.), sepsis accounts for 13% of total hospital expenses and more than 50% of hospital deaths. People with sepsis are more likely to be readmitted. Little is known about the prevalence and outcomes of different hospital readmissions (DHR) in sepsis patients, and the factors associated with DHR have not been well studied.MethodsWe used data during 2010 to 2017 from the Nationwide Readmissions Database of the U.S. 2010 to 2017 to identify the patients with admission for sepsis. Multivariable logistic regression analysis was used to evaluate the associated factors for DHR, and five models were constructed to elucidate the relationship between DHR and in-hospital outcomes.Results From 2010 to 2017, 450,560 (19.65%) of all readmitted sepsis patients in the U.S. were readmitted to a different hospital within 30 days. The prevalence of DHR increased from 18.45% in 2010 to 22.07% in 2017 (P for trend < 0.001). The factors associated with DHR included elective admission, diabetes, drug abuse, alcohol abuse, psychoses, and depression. The most common reason for readmission was infections irrespective of hospital status. DHR was associated with higher hospitalization costs [$4,909, 95% confidence interval (CI), $4,542-$5,276, P<0.001], longer length of stay (LOS) (0.97 days, 95% CI, 0.87 days-1.08 days, P<0.001), and higher risk of in-hospital mortality (odds ratio,1.08, 95% CI, 1.04-1.12, P < 0.001).ConclusionsDHR occurred for one fifth of sepsis patients in the U.S. Our findings suggest that patients readmitted to a different hospital within 30 days may experience higher in-hospital mortality, longer LOS, and higher hospitalization costs. Future studies need to examine whether continuity of care can improve the prognosis of patients with sepsis.

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Comparison of Rates and Outcomes of Readmission to Index vs Nonindex Hospitals After Major Cancer Surgery

Abstract: Approximately one-fifth of readmissions were to a nonindex hospital and were associated with higher mortality and morbidity than readmission to index hospitals. Factors that influence nonindex readmissions have been identified to target interventions.

Cited by 66 publications

References 27 publications

Readmissions after ovarian cancer cytoreduction surgery: The first 30 days and beyond

Readmissions after ovarian cancer cytoreduction surgery: The first 30 days and beyond

Frequency, predictors, and outcomes of readmission to index versus non-index hospitals after mechanical thrombectomy in patients with ischemic stroke

Readmission to a Different Hospital and Worse Outcomes Following Sepsis: A Nationwide Cohort Study

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