Impact of Location of Readmission on Outcomes After Major Cancer Surgery.
BACKGROUND
The burden of readmissions after major cancer surgery is high. Prior work suggests that one-third of readmitted patients are readmitted to a different hospital than where the surgery was performed. The impact of this location of readmission needs to be more thoroughly understood.


METHODS
This retrospective cohort study was performed on Surveillance, Epidemiology, and End Results (SEER)-Medicare patients with bladder, esophagus, lung, or pancreas cancer diagnosed from 2001 to 2007 who underwent extirpative surgery and were readmitted within 90 days. Readmission location was classified as 'index' if readmission was at the hospital where surgery was performed, or 'different' if readmission was elsewhere. Outcomes including complications, reoperations, in-hospital mortality, 90-day mortality, and 90-day total costs were compared based on the location of readmission using a propensity score inverse probability treatment weight analysis.


RESULTS
Overall, 7903 (28 %) patients were readmitted within 90 days of index hospitalization. Thirty-three percent were readmitted to a different hospital (bladder 30 %, esophagus 34 %, lung 34 %, pancreas 34 %). Ninety-day mortality and total costs of care were not significantly different between the readmission location groups (all p > 0.05); however, substantial differences in the types of patients, and timing of and reasons for readmission were observed between the two groups.


CONCLUSIONS
Patients readmitted to different hospitals after major cancer surgery are a different group of patients than those readmitted to the index hospital. Accounting for this, we did not find significant differences in short-term clinical outcomes or costs of care based on readmission location; however, differences in long-term outcomes were observed that should be further explored in future studies.
Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. stitz@med.unc.edu.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA. stitz@med.unc.edu.
Karyn B
KB
Stitzenberg
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
YunKyung
Y
Chang
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.|Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
Angela B
AB
Smith
Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.|Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Michael O
MO
Meyers
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.|Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
Matthew E
ME
Nielsen
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000401:mortality* / Q000601:surgery; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate