Evaluation of 30-day hospital readmission after surgery for advanced-stage ovarian cancer in a medicare population.
OBJECTIVE
To analyze rate, risk factors, and costs associated with 30-day readmission after ovarian cancer surgery.


METHODS
The SEER-Medicare linked database (1992 to 2010) was used to evaluate readmission rates within 30 days of index surgery in patients with stage IIIC/IV ovarian, primary peritoneal, or fallopian tube cancer. Multivariable logistic regression was used to identify factors associated with readmission.


RESULTS
Of 5,152 eligible patients, 1,003 (19.5%) were readmitted within 30 days of discharge. Mean patient age was 75 years. Diagnoses associated with readmission included infection (34.7%), dehydration (34.3%), ileus/obstruction (26.2%), metabolic/electrolyte derangements (23.1%), and anemia (12.3%). In multivariable analysis, year of discharge was significantly associated with 30-day readmission (1996 to 2000: odds ratio [OR], 1.32; 95% CI, 1.01 to 1.71; 2001 to 2005: OR, 1.58; 95% CI, 1.24 to 2.0; 2006 to 2010: OR, 1.73; 95% CI, 1.35 to 2.21; referent years 1992 to 1995), as were length of index hospital stay more than 8 days (OR, 1.39; 95% CI, 1.18 to 1.64) and discharge to a skilled nursing facility (OR, 1.3; 95% CI, 1.04 to 1.63). Patients readmitted within 30 days had a significantly greater 1-year mortality rate compared with patients not readmitted (41.1% v 25.1%, respectively; P < .001). The median cost of readmission hospital stay was $9,220 in year 2010 dollars, with a total cost of $9.3 million over the study period.


CONCLUSIONS
Early readmission after surgery for ovarian cancer is common. There is a significant association between 30-day readmission and 1-year mortality. These findings may catalyze development of targeted interventions to decrease early readmission, improve patient outcomes, and control health care costs.
All authors: University of California, Irvine, Irvine, CA. eskander@uci.edu.
Ramez N
RN
Eskander
All authors: University of California, Irvine, Irvine, CA.
Jenny
J
Chang
All authors: University of California, Irvine, Irvine, CA.
Argyrios
A
Ziogas
All authors: University of California, Irvine, Irvine, CA.
Hoda
H
Anton-Culver
All authors: University of California, Irvine, Irvine, CA.
Robert E
RE
Bristow
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006278:Medicare; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010359:Patient Readmission; D018426:SEER Program; D014481:United States