Evaluation of 30-Day Hospital Readmission After Surgery for Advanced-Stage Ovarian Cancer in a Medicare Population

Abstract

Purpose To analyze rate, risk factors, and costs associated with 30-day readmission after ovarian cancer surgery. Patients and Methods The SEER-Medicare linked database (1992 to 2010) was used to evaluate readmission rates within 30 days of index surgery in patients with stage IIIC/IV ovarian, primary peritoneal, or fallopian tube cancer. Multivariable logistic regression was used to identify factors associated with readmission. Results Of 5,152 eligible patients, 1,003 (19.5%) were readmitted within 30 days of discharge. Mean patient age was 75 years. Diagnoses associated with readmission included infection (34.7%), dehydration (34.3%), ileus/obstruction (26.2%), metabolic/electrolyte derangements (23.1%), and anemia (12.3%). In multivariable analysis, year of discharge was significantly associated with 30-day readmission (1996 to 2000: odds ratio [OR], 1.32; 95% CI, 1.01 to 1.71; 2001 to 2005: OR, 1.58; 95% CI, 1.24 to 2.0; 2006 to 2010: OR, 1.73; 95% CI, 1.35 to 2.21; referent years 1992 to 1995), as were length of index hospital stay more than 8 days (OR, 1.39; 95% CI, 1.18 to 1.64) and discharge to a skilled nursing facility (OR, 1.3; 95% CI, 1.04 to 1.63). Patients readmitted within 30 days had a significantly greater 1-year mortality rate compared with patients not readmitted (41.1% v 25.1%, respectively; P < .001). The median cost of readmission hospital stay was $9,220 in year 2010 dollars, with a total cost of $9.3 million over the study period. Conclusion Early readmission after surgery for ovarian cancer is common. There is a significant association between 30-day readmission and 1-year mortality. These findings may catalyze development of targeted interventions to decrease early readmission, improve patient outcomes, and control health care costs.

The Frequency of Unplanned Rehospitalization and Associated Factors in Gyneoncology Patients: A Retrospective Study

“…23 In addition to the morbidity experienced during the hospitalization, complications that develop during hospitalization for medical and surgical treatment can also result in rehospitalization for the patient. 15,24 In this context, the patients with comorbidity should be carefully examined preoperatively, so as to identify any potential intervention that may decrease their risk for postoperative complications during rehospitalization. In addition, the patient should be cautiously observed during the postoperative hospitalization to ensure that they are fully ready for discharge before their release from the hospital.…”

“…17,20,22,24 In the study conducted by Alhilli et al, 17 it was seen that patients undergoing rehospitalizations experienced more than 1 series admission. Those patients were diagnosed with ovarian cancer with a rate of 57%, cervix with 30%, and uterus with 11%.…”

“…9,20,22 Because of these reasons, it is required to increase the number of hospice and palliative care units and available grants to families or individuals who need home-based health care services. 20,22,24 Besides, Quality Improvement Organizations appear to have reversed a national trend of increased hospitalizations from home settings by working with individual agencies that provide home health care.…”

Risk factors for readmission in patients with ovarian, fallopian tube, and primary peritoneal carcinoma who are receiving front-line chemotherapy on a clinical trial (GOG 218): an NRG oncology/gynecologic oncology group study (ADS-1236)

“…Most recently, Eskander et al reported a SEER review of rehospitalizations following surgery for ovarian cancer in the United States [14]. The goal behind using SEER data is to generate more generalizable results, but specific patient and tumor related data is not available for analysis.…”

“…Eskander's SEER study is notable for the increase in re-hospitalization rates over time, associated with a corresponding decrease in length of stay (LOS) over time [14]. Another study in the gynecology oncology population of patients suggested that LOS could be safely decreased with an overall 5% readmission rate [24].…”