Readmission After Major Cancer Surgery Associated With Discharge Destination and Length of Index Stay
As reported by Stitzenberg et al in the Journal of Clinical Oncology, a study examining the effect of travel distance on inpatient readmission and outcome after major cancer surgery found that predictors of readmission included discharge to somewhere other than home, longer length of stay, comorbidities, higher stage at diagnosis, and longer travel distance. Readmission was associated with poorer survival.
The study involved Surveillance, Epidemiology, and End Results (SEER)–Medicare data on patients undergoing cystectomy (n = 4,940), lung resection (n = 20,362), esophagectomy (n = 1,573), or pancreatectomy (n = 2,844).
Predictors of Readmission
Overall, 30- and 90-day readmission rates ranged from 13% and 23% for lung resection to 30% and 43% for cystectomy. Of readmitted patients, 32% were readmitted more than once.
Significant predictors (all P < .001) of 30-day and 30- to 90-day readmission included discharge to somewhere other than home (incidence rate ratio [IRR] = 1.61 for skilled nursing facility and 3.25 for other destinations associated with 30-day readmission; IRR = 1.46 and 1.62 associated with 90-day readmission), longer length of stay (IRR = 1.03 and 1.01 for days as continuous variable), comorbidities (IRR = 1.46 and 1.42 for Charlson comorbidity score of 2+ vs 0), and higher stage at diagnosis (IRR = 1.44 and 1.95 for distant vs local disease); longer travel distance was associated with increased risk of 30-day readmission (IRR = 1.27 for farthest vs nearest quartile, P < .001).
Longer travel distance (longest vs shortest quartile) from the index hospital was also associated with increased emergency room visits at 30 days (12% vs 8%, P < .001) and 90 days (20% vs 14%, P < .001) and increased rate of readmission to a hospital other than the index hospital (59% vs 11%, P < .001).
Mortality and Costs
Readmission was associated with higher 1-year mortality rates (all P < .001) for patients with bladder cancer (40% vs 24%), esophagus cancer (45% vs 34%), lung cancer (33% vs 15%), and pancreas cancer (55% vs 37%). Median total 90-day costs of care were higher (all P < .001) for readmitted patients with bladder cancer ($45,000 vs $26,000), esophagus cancer ($65,000 vs $40,000), lung cancer ($44,000 vs $26,000), and pancreas cancer ($63,000 vs $45,000).
The investigators concluded: “The burden of readmissions after major cancer surgery is high, resulting in substantially poorer patient outcomes and higher costs. Risk of readmission was most strongly associated with length of stay and discharge destination. Travel distance also has an impact on patterns of readmission. Interventions targeted at higher risk individuals could potentially decrease the population burden of readmissions after major cancer surgery.”
Karyn B. Stitzenberg, MD, MPH, of University of North Carolina, Chapel Hill, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the Integrated Cancer Information and Surveillance System, University of North Carolina Lineberger Comprehensive Cancer Center. 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®.
