Risk Factors for Hospital Readmission after Radical Gastrectomy for Gastric Cancer: A Prospective Study

Abstract

BackgroundHospital readmission is gathering increasing attention as a measure of health care quality and a potential cost-saving target. The purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer.MethodsWe conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. The incidence, cause and risk factors for 30-day readmission were determined.ResultsA total of 376 patients were included in our analysis without loss in follow-up. The 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Factors not associated with a higher readmission rate included a history of a major postoperative complication during the index hospitalization, prolonged primary length of hospital stay after surgery, a history of previous abdominal surgery, advanced age, body mass index, pre-existing cardiopulmonary comorbidities, American Society of Anesthesiology grade, type of resection, extent of node dissection and discharge disposition.ConclusionsReadmission within 30 days of discharge after radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission. Preoperative optimization of nutritional status of patients at nutritional risk may effectively decrease readmission rates.

Risk factors for 30-day unplanned readmission among patients undergoing laparotomy for perforation peritonitis

“…Patient demographics in terms of age, gender and BMI have not been found to affect readmission rates in most of the previous studies. [6][7][8][9][10][11][12][13][14][15][16][17] Among various biochemical parameters, hypoproteinemia was found to be a significant risk factor for readmission in the present study. Though this parameter has not been considered in majority of the studies, some authors have found it to be significant.…”

“…Though this parameter has not been considered in majority of the studies, some authors have found it to be significant. 11,18 This is probably due to the fact that hypoproteinemia predisposes patients to increased risk of infections because of poor immunity. Moreover, hypoproteinemia leads to poor wound healing thus causing increased risk of anastomotic leak as well as wound dehiscence.…”

“…3,6,11,14,15,17,[21][22][23] This is probably because of associated co-morbidities in such cases which put them at a greater risk of developing postoperative complications and thus increased risk of readmission. Patients requiring blood transfusion during their hospital stay were found to be at a significantly higher risk of readmission in the present study.…”

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

“…Institutional and registry data suggest an overall morbidity of approximately 20% and increased risk of readmissions among patients who developed complications (7, 10, 14, 15). The individual effects associated with specific and potentially modifiable risk factors remain poorly defined.…”

Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma

“…Other investigators have focused more on disease-specific populations and reported factors associated with readmission among patients with pancreatic, liver, cholangiocarcinoma, as well as gastric cancer. 23–30 Data on readmission following surgery for ACC remains not defined. Information on ACC may be particularly interesting as readmission might be affected by patient presentation (e.g., age, comorbidities, etc.…”