Uppal S, et al. - A retrospective cohort study was performed in patients undergoing ovarian cancer surgery to assess the role of 30-day readmission rate as a quality of care metric. Researchers reported that hospitals performing 31 cases per year or more had a significantly lower risk-adjusted 30- and 90-day mortality, despite higher rates of complex surgical procedures, and have higher rates of guideline-concordant care delivery.

Methods

• Study participants were women diagnosed between 2004 and 2013 with advanced-stage, high-grade, serous carcinoma who underwent primary treatment.
• Researchers compared the performance of hospital risk-adjusted 30-day readmission rate to other quality of care metrics (risk-adjusted 30- and 90-day mortality, rates of adherence to guideline-based care, and overall survival) within hospitals categorized by yearly case volume (10 or less, 11–20, 21–30, and 31 cases per year or more) using the National Cancer Database.

Results

• Forty-two thousand, nine hundred thirty-one patients met the inclusion criteria.
• The study results showed that the overall unplanned 30-day readmission rate was 6.36% (95% CI 6.13–6.59).
• It was observed that after adjusting for comorbidity, stage, histology, and sociodemographic and treatment factors, hospitals performing 31 cases per year or more had a 24% higher likelihood of readmission (adjusted odds ratio [OR] 1.25, 95% CI 1.06–1.46) when contrasted with those performing 10 cases per year or less.
• Data reported that hospitals performing 31 cases per year or more had a significantly lower risk-adjusted 90-day mortality (adjusted OR 0.74, 95% CI 0.60–0.91) despite higher rates of complex surgical procedures and higher rates of guideline-concordant care delivery (86% vs 77%, P < .001).
• Care at a high-volume hospital was independently predictive of lower hazard of death (adjusted hazard ratio 0.86, 95% CI 0.82–0.90) in the Cox proportional hazards regression model.