Hospital Readmission Is Associated With Poor Survival After Esophagectomy for Esophageal Cancer

Abstract

Background Hospital readmissions are costly and associated with inferior patient outcomes. There is limited knowledge related to readmissions following esophagectomy for malignancy. Our aim was to determine the impact of readmission following esophagectomy on survival. Methods This cohort study utilizes Surveillance, Epidemiology, and End Results-Medicare data (2002–2009). Survival, length of stay (LOS), 30-day readmissions and discharge disposition were determined. Multivariate logistic regression models were created to examine risk factors associated with readmission. Results 1,744 patients with esophageal cancer underwent esophagectomy. 80% (1390) of patients were male and mean age was 73 years. 71.8% (1251) of tumors were adenocarcinomas and 72.5% (1265) were distal esophageal tumors. 38% (667) of patients received induction therapy. Operative approach was transthoracic in 52.6% (918), transhiatal in 37.4% (653) and required complex reconstruction (intestinal interposition) in 9.9% (173). Stage distribution was: Stage I 35.3% (616), Stage II 32.5% (566), Stage III 27.9% (487) and Stage IV 2.3% (40). Median LOS was 13 days, hospital mortality was 9.3% (158) and 30-day readmission rate was 18.6% (212/1139 home discharges). 25.4% (443) were discharged to institutional care facilities. Overall survival was significantly worse for patients readmitted (p<0.0001, log-rank test). Risk factors for readmission were comorbidity score of 3+, urgent admission and urban residence. Conclusions Hospital readmissions following esophagectomy for cancer occur frequently and are associated with worse survival. Improved identification of patients at risk for readmission following esophagectomy can inform patient selection, discharge planning and outpatient monitoring. Optimization of such practices may lead to improved outcomes at reduced cost.

Early Readmissions after Esophagectomy for Esophageal Adenocarcinoma: Does Facility Case-Volume Matter?

“…Other crucial pay-for-performance program in the U.S [9]. Our results indicate that the incidence of 30-day readmission after an esophagectomy continues to be high at 17.20% and is consistent with previous finds [5,6]. e novel aspect of this study is that it compares the incidence of early readmissions following esophagectomy among centers stratified by annual case volume.…”

“…Hospital readmissions following esophagectomy range from 12-25% and are associated with decreased patient survival [3,5,6]. However, data regarding risk factors for early (30-day) readmission after esophagectomy have been conflicting.…”

Socioeconomic Factors Are Associated With Readmission After Lobectomy for Early Stage Lung Cancer

“…19–23 As highlighted by both our study results and those that have been previously published, socioeconomic factors are now starting to be recognized as important preoperative indicators for increased risk of hospital readmission. 9,10,13,23 Although SES factors are non-modifiable in and of themselves, they have been repeatedly linked with poor outcomes, including readmission. 24 Reasons for this finding have included patient preference for hospitalization versus ambulatory care and lack of access to follow-up visits.…”

Transthoracic versus transhiatal resection for esophageal adenocarcinoma of the lower esophagus: A value‐based comparison

“…Given the importance of readmissions as a quality of care metric, readmission rates should be considered in conjunction with other outcomes when determining value. Hospital readmissions following an esophagectomy for esophageal cancer have previously been shown to be a common occurrence, ranging from 5% to 25%, though these reports did not differentiate surgical approaches [25][26][27][28]. In our study, rehospitalization after discharge to home was found to occur frequently.…”