title: Hospital readmission is associated with poor survival after esophagectomy for esophageal cancer.
abstract: BACKGROUND
  Hospital readmissions are costly and associated with inferior patient outcomes. There is limited knowledge related to readmissions after esophagectomy for malignancy. Our aim was to determine the impact on survival of readmission after esophagectomy.
  
  
  METHODS
  This cohort study utilizes Surveillance, Epidemiology, and End Results-Medicare data (2002 to 2009). Survival, length of stay, 30-day readmissions, and discharge disposition were determined. Multivariate logistic regression models were created to examine risk factors associated with readmission.
  
  
  RESULTS
  In all, 1,744 patients with esophageal cancer underwent esophagectomy: 80% of patients (1,390) were male, and mean age was 73 years; 71.8% of tumors (1,251) were adenocarcinomas, and 72.5% (1,265) were distal esophageal tumors; 38% of patients (667) received induction therapy. Operative approach was transthoracic in 52.6% of patients (918) and transhiatal in 37.4% (653), and required complex reconstruction (intestinal interposition) in 9.9% (173). Stage distribution was as follows: stage I, 35.3% (616); stage II, 32.5% (566); stage III, 27.9% (487); and stage IV, 2.3% (40). Median length of stay was 13 days, hospital mortality was 9.3% (158 patients), and 30-day readmission rate was 18.6% (212 of 1,139 home discharges); 25.4% of patients (443) were discharged to institutional care facilities. Overall survival was significantly worse for patients who were readmitted (p < 0.0001, log rank test). Risk factors for readmission were comorbidity score of 3+, urgent admission, and urban residence.
  
  
  CONCLUSIONS
  Hospital readmissions after esophagectomy for cancer occur frequently and are associated with worse survival. Improved identification of patients at risk for readmission after esophagectomy can inform patient selection, discharge planning, and outpatient monitoring. Optimization of such practices may lead to improved outcomes at reduced cost.
authors.affiliation: Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: felix.fernandez@emoryhealthcare.org.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
authors.affiliation: Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Onkar
authors.initials: O
authors.lastname: Khullar
authors.affiliation: Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Renjian
authors.initials: R
authors.lastname: Jiang
authors.affiliation: Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Allan
authors.initials: A
authors.lastname: Pickens
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: David
authors.initials: D
authors.lastname: Howard
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Ward
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Theresa
authors.initials: T
authors.lastname: Gillespie
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate