title: Length of Stay and Readmissions in Mastectomy Patients.
abstract: Interest is growing in preventing readmissions as payers start to link reimbursement to readmission rates. The purpose of this study was to assess factors that contribute to 30-day readmission rates for women undergoing mastectomy for breast cancer. Data from the Pennsylvania Health Care Cost Containment Council were queried for women undergoing mastectomy for breast cancer during 2011 (n = 2,919). The outcomes measured were length of stay (LOS) and 30-day readmission. Univariate comparisons between characteristics of readmitted (n = 172) and nonreadmitted patients were performed using t-tests and chi-square tests. Readmission was modeled using logistic regression; LOS was modeled using linear regression and controlled for potential confounders. In multivariate analyses, patients with peripheral vascular disease were more likely to be readmitted (OR 4.36, p = 0.002). Increased LOS was also associated with increased odds of readmission (OR 1.26, p = <0.0001). Since LOS was an important predictor of readmission we also estimated determinants of LOS using linear regression. The occurrence of reconstructive surgery (p = <0.0001) and renal disease (p < 0.0001) were highly predictive of longer LOS. This study showed peripheral vascular disease and longer lengths of stay were associated with higher odds of readmission in women undergoing mastectomy. Clinicians should be cognizant that optimizing a patient's vascular status before mastectomy may lead to lower rates of readmission. Additional research is needed to determine whether the relationship between readmissions and length of hospital stay is a causative versus associative phenomenon since LOS is a modifiable factor that may lead to lower readmissions.
authors.affiliation: Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Susie X
authors.initials: SX
authors.lastname: Sun
authors.affiliation: Section of Surgical Oncology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Leung
authors.affiliation: Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillon
authors.affiliation: Division of Outcomes Research and Quality, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: breast cancer; length of stay; mastectomy; readmissions