Exploring the Burden of Inpatient Readmissions After Major Cancer Surgery

Stitzenberg, Karyn B.; Chang, Yeon S.; Smith, Angela; Nielsen, Matthew E.

doi:10.1200/jco.2014.55.5938

Cited by 171 publications

(155 citation statements)

References 28 publications

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“…Care fragmentation was the highest for readmitted cystectomy patients (36.2% at 90-day follow-up), and this rate is consistent with findings from previous studies. 7, 11, 20 Therefore, cystectomy patients represent a population of particular interest for future studies on the clinical implications of care fragmentation. However, the rates of care fragmentation were very similar for all procedures, except RPLND at 30-day follow-up, which indicates care fragmentation is equally problematic for all readmitted urologic oncology surgical patients.…”

Section: Discussionmentioning

confidence: 99%

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Quantifying Nonindex Hospital Readmissions and Care Fragmentation after Major Urological Oncology Surgeries in a Nationally Representative Sample

et al. 2017

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Purpose To quantify the underestimation of readmission rates that can occur with institutional databases and the incidence of care fragmentation among patients undergoing urologic oncology procedures in a nationally representative database. Materials and Methods The 2013 Nationwide Readmissions Database was queried for patients undergoing prostatectomy, cystectomy, nephroureterectomy, nephrectomy, partial nephrectomy, and retroperitoneal lymph node dissection for urologic malignancies. Nationally representative 30-day and 90-day readmission and care fragmentation rates were calculated for all procedures. Readmission rates with and without non-index hospital readmissions were compared with Pearson’s chi-square test. Multivariable logistic regression models were used to identify predictors of care fragmentation at 90-day follow-up. Results Among all surgical procedures, readmission rates were consistently underestimated by 17-29% at 90-day follow-up. The rates of care fragmentation among readmitted patients were similar for all procedures ranging from 24-34% at 90-day follow-up. Overall, 1 in 4 readmitted patients would not be captured in institutional databases and 1 in 3 readmitted patients experienced care fragmentation. Multivariable models did not identify a predictor of care fragmentation that was consistent across all procedures. Conclusion The high rate of underestimation of readmission rates across all urologic oncology procedures highlights the importance of linking institutional and payer claims databases to provide more accurate estimates of perioperative outcomes and care utilization. The high rate of care fragmentation across all procedures underlines the need for future efforts to understand the clinical relevance of care fragmentation in urologic oncology patients and to identify patients at risk along with potentially modifiable risk factors for care fragmentation.

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Section: Discussionmentioning

confidence: 99%

“…These time points were chosen because they are commonly reported in the urologic oncology literature as outcome measures. 11, 17 …”

Section: Methodsmentioning

confidence: 99%

Quantifying Nonindex Hospital Readmissions and Care Fragmentation after Major Urological Oncology Surgeries in a Nationally Representative Sample

et al. 2017

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“…The results for length of stay and re-admission emphasise that other relevant outcomes vary along the gradient from low hospital volume (and high mortality) to high volume (and lower mortality). A number of recent studies have explored associations within the wider set of outcomes: hospital volume, length of stay, complications, re-admission, mortality, and cost (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). None of these papers addresses all of the possible associations, but the emerging pattern is one of correlated and consistently favourable outcomes in high-volume hospitals.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England

Møller

Riaz

Holmberg

et al. 2016

European Journal of Cancer

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High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of readmission and death: national cohort analysis in England.Henrik Møller (1, 2, 3, 4), Shama Sheikh (2), Lars Holmberg (1), Erik Jakobsen (5), Jesper Lagergren (1), Richard Page (6), Michael D. Peake (3), Neil Pearce (7), Arnie Purushotham Hospitals with large lung cancer surgical resection volumes were less conservative in their selection of patients for surgical management, and provided a higher resection rate to their geographical population. The large hospitals had shorter length of stay and the odds of readmission were 15% lower in the highest hospital volume quintile compared with the lowest quintile. Mortality risks were 1% after 30 days and 3% after 90 days. Patients from hospitals in the highest volume quintile had about half the odds of death within 30 days than patients from the lowest quintile.Variations in outcomes were all in the same direction, with consistent better outcomes in the larger hospitals. This gives support to the ongoing trend towards centralisation of clinical services, but service re-organisation needs to take account of not only the size of hospitals but also referral routes and patient access.

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“…Among surgical oncology procedures, RC has one of the highest rates of morbidity with approximately 20% of patients experiencing a complication during the index admission and more than 33% of patients experiencing hospital readmission. 14,15 Our findings suggest longer storage duration of RBC units given to RC patients result in a significant increase in infectious complications and overall morbidity rates. However, larger prospective cohort studies are needed to confirm this finding.…”

Section: Discussionmentioning

confidence: 68%

“…14,15 Approximately 33–67% of patients undergoing RC for bladder cancer receive PBTs. 16 RC patients innately experience high rates of PBT (exposure of interest), perioperative morbidity, and readmissions (outcomes of interest).…”

Section: Introductionmentioning

confidence: 99%

Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

Chappidi

Chalfin

Johnson

et al. 2017

Urologic Oncology: Seminars and Original Investigations

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Background Bladder cancer patients undergoing radical cystectomy experience high rates of perioperative blood transfusions and morbidity. The aim of this study was to evaluate the impact of blood storage duration on the risk of adverse perioperative outcomes in this high-risk patient population. Materials and Methods In a retrospective review of radical cystectomy patients from 2010–2014 that received perioperative blood transfusions, the average storage duration for all units transfused was used to classify patients as receiving older blood using three different definitions (≥21 days, ≥28 days, and ≥35 days). Multivariable Poisson regression models were used to determine the adjusted relative risk of perioperative infections and overall morbidity in those given older blood compared to fresher blood. Results A total of 205/451(45%) patients undergoing radical cystectomy received non-irradiated, perioperative blood transfusions. In multivariable modeling, increasing average blood storage duration, as a continuous variable, was associated with an increased risk of infections (RR=1.08 per day, 95%CI 1.01–1.17) and overall morbidity (RR=1.08 per day, 95%CI 1.01–1.15). Furthermore, ≥28 day blood storage (vs. <28) was associated with increased infections (RR=2.69, 95%CI 1.18–6.14) and morbidity (RR=2.54, 95%CI 1.31–4.95), and ≥35 day blood storage (vs. <35) was also associated with increased infections (RR=2.83, 95%CI 1.42–5.66) and morbidity (RR=3.35, 95%CI 1.95–5.77). Conclusions Although blood is stored up to 42 days, storage ≥28 days may expose radical cystectomy patients to increased perioperative infections and overall morbidity compared to storage <28 days. Prospective cohort studies are warranted in cystectomy and other high-risk surgical oncology patients, to better determine the impact of blood storage duration.

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Exploring the Burden of Inpatient Readmissions After Major Cancer Surgery

Cited by 171 publications

References 28 publications

Quantifying Nonindex Hospital Readmissions and Care Fragmentation after Major Urological Oncology Surgeries in a Nationally Representative Sample

Quantifying Nonindex Hospital Readmissions and Care Fragmentation after Major Urological Oncology Surgeries in a Nationally Representative Sample

High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England

Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

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