title: Why are patients being readmitted after surgery for esophageal cancer?
abstract: OBJECTIVE
  Readmission after surgery is an unwanted adverse event that is costly to the healthcare system. We sought to evaluate factors associated with increased risk of readmission and to characterize the nature of these readmissions in patients who have esophageal cancer.
  
  
  METHODS
  A retrospective cohort study was performed in 306 patients with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by esophagectomy at Johns Hopkins Hospital between 1993 and 2011. Logistic regression was used to identify factors associated with 30-day readmission. Readmissions were defined as inpatient admissions to our institution within 30 days of discharge.
  
  
  RESULTS
  The median age at surgery was 61 years; the median postoperative length of stay was 9 days; and 48% of patients had ≥1 postoperative complication (POC). The 30-day readmission rate was 13.7% (42 of 306). In univariate analysis, length of stay and having ≥1 POC were significantly associated with readmission. In multivariate analysis, having ≥1 POC was significantly associated with a >2-fold increase in risk for 30-day readmission (odds ratio 2.35, with 95% confidence interval [1.08-5.09], P = .031) when controlling for age at diagnosis and length of stay. Of the 42 patients who were readmitted, 67% experienced POCs after surgery; 50% of patients who experienced POCs were readmitted for reasons related to their postoperative complication. The most common reasons for readmission were pulmonary issues (29%), anastomotic complications (20%), gastrointestinal concerns (17%), and venous thromboembolism (14%).
  
  
  CONCLUSIONS
  Complications not adequately managed before discharge may lead to readmission. Quality improvement efforts surrounding venous thromboembolism prophylaxis, and discharging patients nothing-by-mouth, may be warranted.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Sneha P
authors.initials: SP
authors.lastname: Shah
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Tim
authors.initials: T
authors.lastname: Xu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Hooker
authors.affiliation: Division of Cancer Biology, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Alicia
authors.initials: A
authors.lastname: Hulbert
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Battafarano
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md; Division of Cancer Biology, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Malcolm V
authors.initials: MV
authors.lastname: Brock
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md. Electronic address: syang7@jhmi.edu.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Yang
mesh_terms: D000368:Aged; D015142:Baltimore; D059186:Chemoradiotherapy, Adjuvant; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Thirty-day readmission; esophageal cancer; length of stay; multimodality therapy; neoadjuvant chemoradiation plus surgery; outcomes; postoperative complications