Zafar SN, et al. - Researchers determined the proportions of readmissions after a major cancer operation to a hospital other than the hospital where the surgery was performed. In addition, they compared the outcomes between index and nonindex hospital readmissions. They identified that nearly one-fifth of readmissions after major cancer surgery were to a nonindex hospital. These nonindex hospital readmissions were associated with significantly higher risk-adjusted mortality and morbidity compared with readmissions to index hospitals. Targeted interventions aimed at reducing nonindex readmissions might improve readmission outcomes overall.

Methods

• Researchers undertook a multicenter, population-based, nationally representative study of adult patients undergoing a major cancer operation (defined as esophagectomies or gastrectomies, hepaticobiliary resections, pancreatectomies, colorectal resections, or cystectomies).
• Retrospective analyses were performed using the Nationwide Readmissions Database (admissions from January 1 through September 30, 2013).
• To determine 90-day readmission characteristics, including timing, cost, and outcomes, descriptive analyses were performed.
• They used multivariate logistic regression to identify factors associated with nonindex vs index readmissions, adjusting for clustering by facility.
• In addition, regression models were used to determine differences in mortality, major complications, and subsequent readmissions between the 2 groups.
• From January 1 through December 31, 2013, they performed data analysis.
• Main outcomes and measures determined were proportion of 90-day readmissions and nonindex readmissions after major cancer surgery, factors associated with nonindex readmissions, and difference between in-hospital mortality, hospital costs, and subsequent readmissions for patients admitted to index vs nonindex hospitals.

Results

• This study included a total of 60,970 patients (mean [SD] age, 67 [13] years; 7619 [55.6%] male and 6075 [44.4%] female).
• Researchers noted the 90-day readmission rate of 23.0%.
• Observations revealed that 20.1% of the 13,695 first readmissions were to a nonindex hospital.
• Type of procedure, comorbidities (OR, 1.40; 95% CI, 1.15-1.70), elective admission (OR, 1.21; 95% CI, 1.06-1.37), discharge to a nursing facility (OR, 1.20; 95% CI, 1.07-1.36), and surgery at a teaching hospital (OR, 1.16; 95% CI, 1.00-1.34) (all P < .05) were identified as the independent factors associated with readmission to a nonindex hospital.
• Patients readmitted to nonindex hospitals showed 31.2% higher odds of mortality (odds ratio, 1.31; 95% CI, 1.05-1.64) and 27.3% higher odds of having a major complication (odds ratio, 1.27; 95% CI, 1.14-1.42) after risk adjustment.
• The two groups were not different in terms of subsequent readmissions and hospital costs.