What are the predictors of emergency department utilization and readmission following extremity bone sarcoma resection?

Abstract

Introduction: Treatment for bone sarcomas are large undertakings. Emergency department (ED) visits and unplanned hospital readmissions are a potential target for cost containment. The purpose of this study was to evaluate the risk factors for ED visits and unplanned readmissions following extremity bone sarcoma surgery. Methods: Data from Optum Labs Data Warehouse, a national administrative claims database, was analyzed to identify patients with extremity bone sarcomas from 2006 to 2017. Multivariable logistic regression was used to identify factors associated with ED visits and readmissions. Results: Of 1390 (743 males, 647 female) adult patients, 137 (12%) visited the ED and 245 (18%) were readmitted within 30 days of discharge. The most common indication for ED visits (n = 63, 45.9%) and readmission (n = 119, 48.5%) were complications of surgery. Length of stay >10 days was associated with ED utilization (OR, 1.83; P = .01) and readmission (OR, 4.47; P < .001). Conclusion: One in ten patients will use the ED, and one in five patients will be readmitted to the hospital within 30 days of discharge following extremity bone sarcoma surgery. Length of stay was associated with ED visits and readmission. These patients could be targeted with alternative management strategies in the outpatient setting with early clinical follow-up to minimize readmission.

Investigating readmission rates for patients undergoing oncologic resection and endoprosthetic reconstruction for primary sarcomas and tumors involving bone

“…The rationale behind this appears to relate to the fact that, for surgical oncologic episodes of care, costs tend to be much higher than most other elective surgeries 13,23 . Despite this focus on readmission and value across surgical oncology as a whole, data to guide Orthopaedic oncologists towards evidence based and value driven care of sarcomas and other oncologic diagnoses remains limited 16–18 . One study by Wellings et al 17 utilized a claims database to investigate the predictors of readmission following extremity bone sarcoma resection.…”

“…Despite this focus on readmission and value across surgical oncology as a whole, data to guide Orthopaedic oncologists towards evidence based and value driven care of sarcomas and other oncologic diagnoses remains limited 16–18 . One study by Wellings et al 17 utilized a claims database to investigate the predictors of readmission following extremity bone sarcoma resection. They found that the readmission rate was 18.0% within 30 days, findings that align with the 19.4% readmission rate in the present study.…”

“…It is difficult to surmise the contributors to such a difference. It is important to point out that, when comparing the present study with that of Wellings et al, 17 different patient populations and methodologies were utilized (a claims database of extremity bone sarcoma vs. an institutional database of primary bone tumors undergoing reconstruction). This may account for the difference observed.…”

“…Unfortunately, Orthopaedic oncology patients represent a distinct Orthopaedic patient population that are particularly susceptible to poor surgical outcomes and an increased risk for hospital readmission 11–13 . While the rate of readmissions across all subgroups for nononcologic Orthopedic surgeries ranges from 1% to 3.5%, 14–16 Orthopaedic oncology patients with a sarcoma of the extremities may experience a readmission rate ranging from 8.0% to 18.0% after surgery 16,17 . While it is clear that Orthopaedic oncology patients are at an increased risk for readmission, it is still not clear why this disparity exists 16–18 .…”

“…Investigations into this subject matter are lacking. Existing studies have relied upon national registries and claims databases 16–18 . While these sources allow for general implications, they lack the granularity necessary to parse out the nuances of readmission in this patient group 16–18 …”