R. C. Langan1,2, C. Huang3, K. Harris1,2,3, S. Colton1, A. L. Potosky2,3,4, L. B. Johnson1,2,3,4, N. M. Shara2,3,5, W. B. Al-Refaie1,2,3,4 1Georgetown University Hospital,Department Of Surgery,Washington, DC, USA 2MedStar-Georgetown Surgical Outcomes Research Center,Washington, DC, USA 3MedStar Health Research Institute,Washington, DC, USA 4Lombardi Comprehensive Cancer Center,Washington, DC, USA 5Georgetown-Howard Universities Center For Clinical And Translational Sciences,Washington, DC, USA
Introduction: Readmissions are a focus of emerging efforts to improve the quality and affordability of healthcare. Yet, 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 seven types of major thoracic or abdomino-pelvic cancer surgery within a large multihospital system from 2003-2012. Multivariate logistic regression analyses were conducted to identify predictors of 30- and 90-day hospital readmission.
Results: Overall 30-day and 90-day readmission rates were 16% and 24% with the majority of readmissions occuring within 15-days of discharge. Principal diagnoses of 30-day readmissions included gastrointestinal, pulmonary and infections complications. 30-day readmissions were associated with > 2 comorbid conditions and ≥ 2 postoperative complications. Readmissions significanctly varied 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 (Table 1).
Conclusion: In this large multi-hospital study of older adults, multi-morbidities, procedure type, increased complications and the treating hospital predicted 30- and 90-day readmissions. These findings point toward the potential impact of hospital-level factors behind these readmissions. Our results also point towards the importance of assessing the influence of readmission on other important cancer care metrics; patient reported outcomes and the completion of adjuvant systemic therapies.
