Unplanned 30-day hospital readmission as a quality measure in gynecologic oncology.
OBJECTIVE
Thirty-day readmission is used as a quality measure for patient care and Medicare-based hospital reimbursement. The primary study objective was to describe the 30-day readmission rate to an academic gynecologic oncology service. Secondary objectives were to identify risk factors and costs related to readmission.


METHODS
This was a retrospective, concurrent cohort study of all surgical admissions to an academic, high volume gynecologic oncology service during a two-year period (2013-2014). Data were collected on patient demographics, medical comorbidities, psychosocial risk factors, and results from a hospital discharge screening survey. Mixed logistic regression was used to identify factors associated with 30-day readmission and costs of readmission were assessed.


RESULTS
During the two-year study period, 1605 women underwent an index surgical admission. Among this population, a total of 177 readmissions (11.0%) in 135 unique patients occurred. In a surgical subpopulation with >1 night stay, a readmission rate of 20.9% was observed. The mean interval to readmission was 11.8days (SD 10.7) and mean length of readmission stay was 5.1days (SD 5.0). Factors associated with readmission included radical surgery for ovarian cancer (OR 2.87) or cervical cancer (OR 4.33), creation of an ostomy (OR 11.44), a Charlson score of ≥5 (OR 2.15), a language barrier (OR 3.36), a median household income in the lowest quartile (OR 6.49), and a positive discharge screen (OR 2.85). The mean cost per readmission was $25,416 (SD $26,736), with the highest costs associated with gastrointestinal complications at $32,432 (SD $32,148). The total readmission-related costs during the study period were $4,523,959.


CONCLUSIONS
Readmissions to a high volume gynecologic oncology service were costly and related to radical surgery for ovarian and cervical cancer as well as to medical, socioeconomic and psychosocial patient variables. These data may inform interventional studies aimed at decreasing unplanned readmissions in gynecologic oncology surgical populations.
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, United States.
MaryAnn B
MB
Wilbur
Johns Hopkins School of Medicine, Baltimore, MD, United States.
Diana B
DB
Mannschreck
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, United States.
Ana M
AM
Angarita
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States.
Rayna K
RK
Matsuno
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, United States.
Edward J
EJ
Tanner
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, United States.
Rebecca L
RL
Stone
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, United States.
Kimberly L
KL
Levinson
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, United States.
Sarah M
SM
Temkin
Division of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, MD, United States.
Martin A
MA
Makary
Care Coordination and Clinical Resource Management, Johns Hopkins Hospital, Baltimore, MD, United States.
Curtis A
CA
Leung
Care Coordination and Clinical Resource Management, Johns Hopkins Hospital, Baltimore, MD, United States.
Amy
A
Deutschendorf
Division of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, MD, United States.
Peter J
PJ
Pronovost
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, United States.
Amy
A
Brown
Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore, MD, United States. Electronic address: afader1@jhmi.edu.
Amanda N
AN
Fader
D000046:Academic Medical Centers; D000428:Alcohol Drinking / Q000453:epidemiology; D015331:Cohort Studies; D003144:Communication Barriers; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D017048:Health Care Costs; D006302:Health Services Research; D017721:Hospital Costs; D061847:Hospitals, High-Volume; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D009775:Obstetrics and Gynecology Department, Hospital; D016522:Oncology Service, Hospital; D010030:Ostomy / Q000706:statistics & numerical data; D010051:Ovarian Neoplasms / Q000601:surgery; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D002583:Uterine Cervical Neoplasms / Q000601:surgery
Gynecologic cancer surgery; Health care costs; Hospital readmissions