Transarterial Chemoembolization in the Coming Era of Decreased Reimbursement for Readmissions.
OBJECTIVE
CMS has identified readmission of patients within 30 days of discharge as a targeted quality metric and has instituted financial penalties to encourage hospitals to reduce readmissions. The aims of this study were to examine the rate of 30-day admissions after transarterial chemoembolization (TACE) at a single institution and to identify potential factors associated with readmission.


METHODS
A total of 275 patients were identified who underwent a total of 457 TACE procedures over a 21-year period. Their electronic medical records were reviewed to evaluate the 30-day readmission rate in all patients undergoing TACE, and multiple logistic regression analysis was used to ascertain any clinical or demographic factors affecting the risk for readmission.


RESULTS
Nineteen patients (4.2%) required readmission to the hospital within 30 days; 11 of these readmissions were directly attributable to TACE, with inpatient stays upon readmission ranging from 2 to 27 days. Fourteen patients (3.1%) returned to the emergency department (ED) within 30 days of TACE. Medicare patients were more likely to be readmitted to the hospital or require emergency department treatment within 30 days than patients with private health insurance (P = .006). Patients with worse performance status (Eastern Cooperative Oncology Group) were also more likely to require emergency department care within 30 days (P = .04).


CONCLUSIONS
TACE patients are at risk for readmission, often related to underlying medical comorbidities. Although extensively studied in other specialties, the Hospital Readmissions Reduction Program has received little attention in the radiology literature, and radiologists should familiarize themselves with this continually expanding initiative.
Department of Imaging, Division of Vascular and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Colin J
CJ
McCarthy
Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Andrew X
AX
Zhu
Department of Imaging, Division of Vascular and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Shehab A
SA
Alansari
Biomaterials Innovation Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, Massachusetts; Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, Arizona. Electronic address: oklu.rahmi@mayo.edu.
Rahmi
R
Oklu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston / Q000453:epidemiology; D016461:Chemoembolization, Therapeutic / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005544:Forecasting; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D008113:Liver Neoplasms / Q000191:economics* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D015641:Radiography, Interventional / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends
TACE; chemoembolization; oncology; readmissions; transarterial