Thirty‐day hospital readmission rate, reasons, and risk factors after acute inpatient cancer rehabilitation

Tennison, Jegy M.; Rianon, Nahid J; Manzano, Joanna Grace M.; Munsell, Mark F.; George, Marina; Bruera, Éduardo

doi:10.1002/cam4.4154

Cited by 13 publications

(16 citation statements)

References 29 publications

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“…If patients cannot manage their bladders adequately, urological complications can occur. Urological complications such as urolithiasis and renal failure have been reported to cause hospital readmissions shortly after discharge from acute inpatient cancer rehabilitation, increasing the 30-day readmission rate [26]. Of note, acute renal insufficiency or failure was our study's third most frequent type of acute urinary dysfunction.…”

Section: Discussionmentioning

confidence: 62%

Urinary Dysfunction: Frequency, Risk factors, and Interventions in patients with Cancer during Acute Inpatient Rehabilitation

Tennison¹,

Pally²,

Fellman³

et al. 2023

J. Cancer

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Introduction: Urinary dysfunction has a strong impact clinically, socially, and economically. Although the development of acute urinary dysfunction in hospitalized patients with cancer is common in clinical practice, its occurrence and management strategies are scant in the literature. It has been reported as one of the more common medical complications in patients with cancer undergoing acute inpatient rehabilitation. This study assessed the frequency of and risk factors for acute urinary dysfunction among these patients and identified the interventions used for management. Methods: This is a retrospective study of consecutive patients admitted to a National Cancer Institute Comprehensive Cancer Center's acute inpatient rehabilitation service from 9/1/2020 through 3/15/2021. We excluded patients that were readmissions during the study time frame. We collected patients' demographic, clinical, and functional data. We defined acute urinary dysfunction as the development of any new urinary symptom(s) or diagnosis, which involved additional work-up and/or management after admission to the acute inpatient rehabilitation service. Results: Of the 176 total patients included in this study, 47 (27%; 95% confidence interval [CI], 20-34) patients had acute urinary dysfunction. The most frequent diagnoses were urinary tract infection (32%) and neurogenic bladder (26%). The most common tests were urine cultures (32%) and urinalyses (30%). The most commonly prescribed medications were antibiotics (32%) and alpha-1 blockers (15%). Other most frequent interventions included timed voiding (34%) and intermittent catheterization with bladder scans (28%). Acute urinary dysfunction was associated with an increased length of stay on the inpatient rehabilitation service (odds ratio [OR], 1.13; 95% CI, 1.06-1.20; P<.001), surgery during the index admission (OR, 2.50; 95% CI, 1.21-5.16; P=.014), and fecal incontinence (OR, 6.41; 95% CI, P=.004). Conclusion: Acute urinary dysfunction was noted to be a substantial problem in this cohort. This is an overlooked dimension of inpatient cancer rehabilitation that deserves more attention. Patients at risk for acute urinary dysfunction may benefit from close monitoring for medical management and rehabilitation interventions to maximize functional independence with bladder care. More research regarding acute urinary dysfunction types and management approaches in post-acute care settings for patients with cancer is justified.

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Section: Discussionmentioning

confidence: 62%

Urinary Dysfunction: Frequency, Risk factors, and Interventions in patients with Cancer during Acute Inpatient Rehabilitation

Tennison¹,

Pally²,

Fellman³

et al. 2023

J. Cancer

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“…The readmissions were all because of medical reasons except for 1 (0.4%) patient who had a fall. 47 There are some limitations to this study. There was a smaller sample size compared with other studies looking at falls, but this is reflective of the number of falls during the time frame chosen.…”

Section: Discussionmentioning

confidence: 94%

Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit

Gupta

Tennison

Shin

et al. 2023

JCO Oncology Practice

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PURPOSE: Falls in the hospital can lead to adverse events, including injuries. Studies have shown that patients with cancer and those undergoing inpatient rehabilitation (IPR) are at higher risk for falls. Therefore, we measured the frequency, degree of harm, and characteristics of patients who fell in an inpatient cancer rehabilitation unit. METHODS: A retrospective review was conducted on inpatient cancer rehabilitation patients admitted from January 2012 to February 2016. Fall frequency, degree of harm, fall circumstances, cancer type, patient's fall risk score on the basis of the MD Anderson Cancer Center Adult Inpatient Fall Risk Assessment Tool (MAIFRAT), length of stay, and risk factors were evaluated for patients. RESULTS: There were 72 out of 1,571 unique individual falls (4.6%), with a falls incidence of 3.76 falls per 1,000 patient-days. Most fallers (86%) suffered no harm. Risk factors for falls included presence of patient-controlled analgesia pump ( P = .03), pump such as insulin or wound vacuum-assisted closure ( P < .01), nasogastric, gastric, or chest tube ( P = .05), and higher MAIFRAT score ( P < .01). The fallers were younger (62 v 66; P = .04), had a longer IPR stay (13 v 9; P = .03), and had a lower Charlson comorbidity index (6 v 8; P < .01). CONCLUSION: The frequency and degree of harm for falls in the IPR unit were less than previous studies, which suggests that mobilization for these patients with cancer is safe. The presence of certain medical devices may contribute to fall risk, and more research is needed to better prevent falls in this higher-risk subgroup.

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“…8,9 In recent years, CMS has also used 30-day readmission to acute care hospitals following discharge from IRFs as a measure to evaluate the quality of care at IRFs. [10][11][12] In addition, many studies have been conducted to access the rate, reasons, and risk factors for readmission to acute care hospitals after discharge from IRFs. [10][11][12][13][14][15] The most studied populations were patients with stroke, lower extremity joint replacement, debility, brain injury, and cancer.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] In addition, many studies have been conducted to access the rate, reasons, and risk factors for readmission to acute care hospitals after discharge from IRFs. [10][11][12][13][14][15] The most studied populations were patients with stroke, lower extremity joint replacement, debility, brain injury, and cancer. [10][11][12][13][14][15] However, there have been limited studies focused on identifying risk factors for specific patient populations in IRFs to be readmitted to acute care hospitals before completion of their inpatient rehabilitation program.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13][14][15] The most studied populations were patients with stroke, lower extremity joint replacement, debility, brain injury, and cancer. [10][11][12][13][14][15] However, there have been limited studies focused on identifying risk factors for specific patient populations in IRFs to be readmitted to acute care hospitals before completion of their inpatient rehabilitation program. 11,16,17 Many variables may be associated with readmissions of patients with amputation to acute care hospitals from IRFs that have never been studied before.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for readmission of patients with amputation to acute care from inpatient rehabilitation: A retrospective cohort study

Chang

Lopez

Mei

et al. 2023

PM&R

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IntroductionAmputation is a major condition that requires inpatient rehabilitation. Some research has been conducted to explore the risk factors for readmission of patients from inpatient rehabilitation facilities to acute care hospitals. However, few studies have included patients with amputation in the study population.ObjectiveThis study aimed to identify the risk factors for readmission of patients with amputation to acute care hospitals from an inpatient rehabilitation facility.DesignRetrospective cohort study.SettingAn acute rehabilitation hospital associated with a community‐based tertiary medical center.PatientsA retrospective review of 156 independent admissions of 145 patients from June 2019 to July 2022.Main Outcome MeasureThe study outcome measure was readmission to acute care from an acute rehabilitation unit.ResultsOf the 156 independent admissions, the readmission rate was 19%(29/156). The most common cause of transfer was incision‐site complications (9/29, 31%) including wound infection and wound dehiscence. Patients with amputation readmitted to acute care are more likely to be on dialysis(p < 0.001), have a longer length of stay in acute care before admission to the rehabilitation facility(p = 0.039), and lower Section GG score on admission(p < 0.001). Age, sex, ethnicity, amputation level and history of diabetes mellitus were not associated with acute care hospital readmission. The logistic regression model revealed that patients being on dialysis was the only significant risk factor predictive of readmission to acute care (odds ration[OR] 4.82, p = 0.006).ConclusionsThis study showed that incision‐site complications were the most common cause of disruption in inpatient rehabilitation via acute hospital readmission in patients with amputation. Being on dialysis was associated with a higher risk of readmission to acute care hospitals. Based on the results of this study, specific rehabilitation plans might be required for patients with amputation that carry certain risk factors to reduce rehospitalization to the acute care unit.This article is protected by copyright. All rights reserved.

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Thirty‐day hospital readmission rate, reasons, and risk factors after acute inpatient cancer rehabilitation

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 13 publications

References 29 publications

Urinary Dysfunction: Frequency, Risk factors, and Interventions in patients with Cancer during Acute Inpatient Rehabilitation

Urinary Dysfunction: Frequency, Risk factors, and Interventions in patients with Cancer during Acute Inpatient Rehabilitation

Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit

Risk factors for readmission of patients with amputation to acute care from inpatient rehabilitation: A retrospective cohort study

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