title: Exploring the burden of inpatient readmissions after major cancer surgery.
abstract: OBJECTIVE
  Travel distances to care have increased substantially with centralization of complex cancer procedures at high-volume centers. We hypothesize that longer travel distances are associated with higher rates of postoperative readmission and poorer outcomes.
  
  
  METHODS
  SEER-Medicare patients with bladder, lung, pancreas, or esophagus cancer who were diagnosed in 2001 to 2007 and underwent extirpative surgery were included. Readmission rates and survival were calculated using Kaplan-Meier functions. Multivariable negative binomial models were used to examine factors associated with readmission.
  
  
  RESULTS
  Four thousand nine hundred forty cystectomies, 1,573 esophagectomies, 20,362 lung resections, and 2,844 pancreatectomies were included. Thirty- and 90-day readmission rates ranged from 13% to 29% and 23% to 43%, respectively, based on tumor type. Predictors of readmission were discharge to somewhere other than home, longer length of stay, comorbidities, higher stage at diagnosis, and longer travel distance (P < .001 for each). Patients who lived farther from the index hospital also had increased emergency room visits and were more likely to be readmitted to a hospital other than the index hospital (P < .001). Of readmitted patients, 31.9% were readmitted more than once. Long-term survival was worse and costs of care higher for patients who were readmitted (P < .001 for all).
  
  
  CONCLUSIONS
  The burden of readmissions after major cancer surgery is high, resulting in substantially poorer patient outcomes and higher costs. Risk of readmission was most strongly associated with length of stay and discharge destination. Travel distance also has an impact on patterns of readmission. Interventions targeted at higher risk individuals could potentially decrease the population burden of readmissions after major cancer surgery.
authors.affiliation: All authors: University of North Carolina, Chapel Hill, NC. stitz@med.unc.edu.
authors.forename: Karyn B
authors.initials: KB
authors.lastname: Stitzenberg
authors.affiliation: All authors: University of North Carolina, Chapel Hill, NC.
authors.forename: YunKyung
authors.initials: Y
authors.lastname: Chang
authors.affiliation: All authors: University of North Carolina, Chapel Hill, NC.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
authors.affiliation: All authors: University of North Carolina, Chapel Hill, NC.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017281:Cost of Illness; D015653:Cystectomy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery; D008297:Male; D006278:Medicare; D009369:Neoplasms / Q000401:mortality* / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011013:Pneumonectomy; D011183:Postoperative Complications; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D014195:Travel; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery