title: Readmissions after major cancer surgery among older adults.
abstract: BACKGROUND
  Decreasing readmissions has become a focus of emerging efforts to improve the quality and affordability of health care. However, little is known about reasons for readmissions after major cancer surgery in the expanding elderly population (≥65 years) who are also at increased risk of adverse operative events. We sought to identify (1) the extent to which older age impacts readmissions and (2) factors predictive of 30- and 90-day readmissions after major cancer surgery among older adults.
  
  
  METHODS
  We identified 2,797 older adults who underwent 1 of 7 types of major thoracic or abdominopelvic cancer surgery within a large multihospital system from 2003 to 2012. Multivariate logistic regression analyses were conducted to identify predictors of 30- and 90-day readmission controlling for covariates.
  
  
  RESULTS
  Overall 30- and 90-day readmission rates were 16% and 24% with the majority of readmissions occurring within 15-days of discharge. Principal diagnoses of 30-day readmissions included gastrointestinal, pulmonary, and infections complications. The 30-day readmissions were associated with >2 comorbid conditions and ≥2 postoperative complications. Readmissions varied significantly according to cancer surgery type and across treating hospitals. Readmissions did not vary by increasing age. Factors associated with 90-day readmission were comparable to those observed at 30 days.
  
  
  CONCLUSIONS
  In this large, multihospital study of older adults, multiple morbidities, procedure type, greater number of complications, and the treating hospital predicted 30- and 90-day readmissions. These findings point toward the potential impact of hospital-level factors behind readmission. Our results also heighten the importance of assessing the influence of readmission on other important cancer care metrics, namely, patient-reported outcomes and the completion of adjuvant systemic therapies.
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Langan
authors.affiliation: MedStar Health Research Institute, Washington, DC.
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC.
authors.forename: Scott
authors.initials: S
authors.lastname: Colton
authors.affiliation: MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Lombardi Comprehensive Cancer Center, Washington, DC.
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Lombardi Comprehensive Cancer Center, Washington, DC.
authors.forename: Lynt B
authors.initials: LB
authors.lastname: Johnson
authors.affiliation: MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC.
authors.forename: Nawar M
authors.initials: NM
authors.lastname: Shara
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Lombardi Comprehensive Cancer Center, Washington, DC. Electronic address: Waddah.B.Al-Refaie@gunet.georgetown.edu.
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
mesh_terms: D000008:Abdominal Neoplasms / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore; D004219:District of Columbia; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D010386:Pelvic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013899:Thoracic Neoplasms / Q000601:surgery*; D016896:Treatment Outcome