Background
Decreasing readmissions has become a focus of emerging efforts to improve the quality
and affordability of health care. However, little is known about reasons for readmissions
after major cancer surgery in the expanding elderly population (≥65 years) who are
also at increased risk of adverse operative events. We sought to identify (1) the
extent to which older age impacts readmissions and (2) factors predictive of 30- and
90-day readmissions after major cancer surgery among older adults.
Methods
We identified 2,797 older adults who underwent 1 of 7 types of major thoracic or abdominopelvic
cancer surgery within a large multihospital system from 2003 to 2012. Multivariate
logistic regression analyses were conducted to identify predictors of 30- and 90-day
readmission controlling for covariates.
Results
Overall 30- and 90-day readmission rates were 16% and 24% with the majority of readmissions
occurring within 15-days of discharge. Principal diagnoses of 30-day readmissions
included gastrointestinal, pulmonary, and infections complications. The 30-day readmissions
were associated with >2 comorbid conditions and ≥2 postoperative complications. Readmissions
varied significantly according to cancer surgery type and across treating hospitals.
Readmissions did not vary by increasing age. Factors associated with 90-day readmission
were comparable to those observed at 30 days.
Conclusion
In this large, multihospital study of older adults, multiple morbidities, procedure
type, greater number of complications, and the treating hospital predicted 30- and
90-day readmissions. These findings point toward the potential impact of hospital-level
factors behind readmission. Our results also heighten the importance of assessing
the influence of readmission on other important cancer care metrics, namely, patient-reported
outcomes and the completion of adjuvant systemic therapies.
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Article info
Publication history
Published online: May 20, 2015
Accepted:
January 25,
2015
Footnotes
Supported by the MedStar-Georgetown Partnership Award.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
