title: Readmission predicts 90-day mortality after esophagectomy: Analysis of Surveillance, Epidemiology, and End Results Registry linked to Medicare outcomes.
abstract: OBJECTIVE
  Postoperative readmission is an increasingly scrutinized quality metric that affects patient satisfaction and cost. Even more important is its implication for short-term prognosis. The purpose of this study is to characterize postesophagectomy readmissions and determine their relationship with subsequent 90-day mortality.
  
  
  METHODS
  Data were extracted for esophagectomy patients from the linked SEER-Medicare Registry (2000-2009), which provides longitudinal information about Medicare beneficiaries who have cancer. We assessed demographics, comorbidities, 30-day readmission, and 90-day mortality. Readmitting facility and diagnoses were identified. A hierarchic multivariable regression model clustered at the hospital level assessed the relationship between readmission within 30 days of discharge and 90-day mortality.
  
  
  RESULTS
  We identified 1543 patients discharged alive after esophagectomy. Among patients discharged alive, the readmission rate was 319 of 1543 (20.7%); 107 of 319 (33.5%) readmissions were to facilities that did not perform the index operation. Mortality rate at 90 days among patients discharged alive was 98 of 1543 (6.4%). Readmission was associated with a 4-fold increase in mortality (16.3% vs 3.8%, P < .001). Using multivariable regression, readmission was the strongest predictor of mortality (odds ratio 6.64, P < .001), with a stronger association than age, Charlson score, and index length of stay. Readmission diagnoses with the highest mortality rates were those associated with pulmonary, gastrointestinal, and cardiovascular diagnoses.
  
  
  CONCLUSIONS
  Patients readmitted within 30 days of discharge after esophagectomy are at exceptionally high risk for early mortality. Early recognition of life-threatening readmission diagnoses is essential to providing optimal care.
authors.affiliation: Division of Thoracic Surgery/Department of Surgery, University of Virginia Health System, Charlottesville, Va.
authors.forename: Yinin
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Va.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: McMurry
authors.affiliation: Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Va.
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.affiliation: Division of Thoracic Surgery/Department of Surgery, University of Virginia Health System, Charlottesville, Va; Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Va. Electronic address: bdk8g@virginia.edu.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: esophageal cancer; esophagectomy; outcomes; postoperative mortality; postoperative readmission