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High and Increasing 30-Day Hospital Readmission After Surgery for Advanced Ovarian Cancer in Medicare Population

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Key Points

  • Rates of early readmission have significantly increased over time.
  • Early readmission was associated with significantly greater 1-year mortality.

In a study reported in the Journal of Clinical Oncology, Eskander et al found that rates of 30-day hospital readmission after surgery for advanced ovarian cancer are high and have increased significantly in recent years.

In the study, the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was used to evaluate readmission rates within 30 days of index surgery for 1992 to 2010 in 5,152 patients with stage IIIC/IV ovarian, primary peritoneal, or fallopian tube cancer. Patients had a median age of 75 years.

Early Readmission Rates

Among all patients, 888 (17.2%) were readmitted at least once within 30 days of discharge (total of 1,003 readmissions). The proportion of patients with early readmission increased from 13.4% in 1992 to 1995 to 15.9% in 1996 to 2000, 18.3% in 2001 to 2005, and 19.3% in 2006 to 2010. The most common diagnoses associated with readmission were infection (34.7%), dehydration (34.3%), hypertension (33.9%), ileus/obstruction (26.2%), metabolic/electrolyte derangements (23.1%), and anemia (12.3%).

Factors in Readmission

In multivariate analysis adjusting for age at diagnosis, Charlson comorbidity score, tumor stage, index surgery complication, and type of index surgery, factors significantly associated with early readmission were discharge during the periods 1996 to 2000 (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.01–1.71), 2001 to 2005 (OR = 1.58, 95% CI = 1.24–2.0), and 2006 to 2010 (OR = 1.73, 95% CI = 1.35–2.21) vs 1992 to 1995, index hospital stay > 8 days (OR = 1.39, 95% CI = 1.18–1.64), and discharge to a skilled nursing facility vs home (OR = 1.35, 95% CI = 1.08–1.70).

Between 1992 and 2010, there appeared to be a trend toward decreasing length of index stay (decrease in median from 14.1 to 9.6 days) and increasing 30-day readmission rate (from 13.4% to 19.3%; P = .135).

Patients readmitted within 30 days had significantly greater 1-year mortality (41.1% vs 25.1%, P < .001). The median cost of readmission hospital stay was $9,220 in 2010 dollars, yielding a total cost of $9.3 million over the study period.

Conclusion

The investigators concluded: “Early readmission after surgery for ovarian cancer is common. There is a significant association between 30-day readmission and 1-year mortality. These findings may catalyze development of targeted interventions to decrease early readmission, improve patient outcomes, and control health care costs.”

Ramez N. Eskander, MD, of University of California, Irvine Medical Center, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by a Ruth L. Kirschstein National Research Service Award grant and a gift from the Queen of Hearts Foundation. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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