Key result
Non-index readmission after cancer surgery is linked to ~31% higher in-hospital mortality and more repeated readmissions.
Why the study?
Does non-index readmission increase in-hospital mortality and repeated readmission in patients readmitted after major cancer surgery?
Cohort (n=9,233)
Yes
Does non-index readmission increase in-hospital mortality and repeated readmission in patients readmitted after major cancer surgery?
Odds Ratio: 1.31 (95% CI 1.03–1.66)
Non-index readmissions after major cancer surgery are associated with higher rates of repeated readmissions, highlighting the negative impact of care fragmentation.
Non-index readmissions after cancer surgery raise odds of repeat events; leaves open whether coordination reduces risk in observational data.
BACKGROUND: Despite national emphasis on care coordination, little is known about how fragmentation affects cancer surgery outcomes. Our study examines a specific form of fragmentation in post-discharge care-readmission to a hospital different from the location of the operation-and evaluates its causes and consequences among patients readmitted after major cancer surgery. STUDY DESIGN: We used the State Inpatient Database of California (2004 to 2011) to identify patients who had major cancer surgery and their subsequent readmissions. Logistic models were used to examine correlates of non-index readmissions and to assess associations between location of readmission and outcomes, measured by in-hospital mortality and repeated readmission. RESULTS: Of 9,233 readmissions within 30 days of discharge after major cancer surgery, 20.0% occurred in non-index hospitals. Non-index readmissions were associated with emergency readmission (odds ratio [OR] = 2.63; 95% CI, 2.26-3.06), rural residence (OR = 1.81; 95% CI, 1.61-2.04), and extensive procedures (eg hepatectomy vs proctectomy; OR = 2.77; CI, 2.08-3.70). Mortality was higher during non-index readmissions than index readmissions independent of patient, procedure, and hospital factors (OR = 1.31; 95% CI, 1.03-1.66), but was mitigated by adjusting for conditions present at readmission (OR = 1.24; 95% CI, 0.98-1.58). Non-index readmission predicted higher odds of repeated readmission within 60 days of discharge from the first readmission (OR = 1.16; 95% CI, 1.02-1.32), independent of all covariates. CONCLUSIONS: Non-index readmissions constitute a substantial proportion of all readmissions after major cancer surgery. They are associated with more repeated readmissions and can be caused by severe surgical complications and increased travel burden. Overcoming disadvantages of non-index readmissions represents an opportunity to improve outcomes for patients having major cancer surgery.
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Zheng et al. (2016) conducted a cohort in Major cancer surgery (n=9,233). Non-index readmission vs. Index readmission was evaluated on In-hospital mortality (OR 1.31, 95% CI 1.03-1.66). Non-index readmission after major cancer surgery was associated with higher in-hospital mortality (OR 1.31; 95% CI 1.03-1.66) and increased odds of repeated readmission within 60 days.
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