title: Hospital Readmission Following Surgery for Gastric Cancer: Frequency, Timing, Etiologies, and Survival.
abstract: BACKGROUND
  Readmission rates after cancer surgery are infrequently reported, and better understanding of the etiologies for readmission is necessary. We sought to investigate the frequency, timing, and etiologies for hospital readmission after surgery for gastric cancer and whether readmission correlates with clinical outcomes.
  
  
  METHODS
  Hospital readmission was examined through linkage of the California Cancer Registry with the Office of Statewide Health Planning and Development database. Patients with gastric adenocarcinoma who had undergone curative intent surgery between 2000 and 2011 were identified. First readmission within 90 days of initial surgery was analyzed with respect to timing (0-30, 31-60, and 61-90 days) and etiology for readmission. Variables associated with readmission and impact on 5-year overall survival (OS) were examined.
  
  
  RESULTS
  A total of 8887 (male, n = 5326; female, n = 3561) patients underwent curative intent surgery for gastric adenocarcinoma. Within 90 days of initial surgery, 2559 (28.8 %) patients had inpatient hospital readmission. The majority of readmissions occurred in the first 30 days [0-30, n = 1371 (53.6 %); 31-60, n = 773 (30.2 %); and 61-90, n = 415 (16.2 %)]. Readmission vs. no readmission within 90 days correlated with worse 5-year OS in patients with local (51.2 vs. 70.9 %, p < 0.0001) and regional (23.3 vs. 32.9 %, p < 0.0001) disease. On multivariate analysis, readmission within 90 days was associated with worse OS (HR 1.40, 95 % CI 1.32-1.49, p < 0.001).
  
  
  CONCLUSIONS
  Hospital readmissions are high after surgery for gastric cancer and correlate with poor patient survival. A better understanding of these issues may allow health care providers to potentially lower readmission rates and improve gastric cancer outcomes.
authors.affiliation: Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Shaila J
authors.initials: SJ
authors.lastname: Merchant
authors.affiliation: Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Philip H G
authors.initials: PH
authors.lastname: Ituarte
authors.affiliation: Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Choi
authors.affiliation: Nursing Research and Education, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Sun
authors.affiliation: Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chao
authors.affiliation: Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Byrne
authors.initials: B
authors.lastname: Lee
authors.affiliation: Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA. joekim7@yahoo.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Gastric cancer; Readmission; Surgery; Survival