Nationwide Analysis of 30-Day Readmissions After Esophagectomy: Causes, Costs, and Risk Factors

Nicholas J. Goel, Amit Iyengar, John J. Kelly, Constantine Mavroudis, Catherine Lancaster, Noel N. Williams, Daniel T. Dempsey, John Kucharczuk

Research output: Contribution to journalArticle

Abstract

Background: Postsurgical readmissions are an increasingly scrutinized marker of health care quality. We sought to estimate the rate, risk factors, causes, and costs associated with readmissions after esophagectomy in a large, nationally representative cohort. Methods: We studied patients from the Nationwide Readmissions Database undergoing esophagectomy from 2010 to 2014. Data were collected on the prevalence and indications for readmission within 30 days as well as the hospital-, procedure-, and patient-level risk factors as determined by multivariable logistic regression. Results: Among 13,282 cases, the rate of 30-day readmission was 19.4%, with the most common indications for readmission being pulmonary (20.6%) and gastrointestinal complications (20%). Median cost of readmission was $9660 (interquartile range, $5392 to $20,447), and pulmonary complications accounted for the greatest total cost burden at 25.8% of all readmission-related costs. Independent risk factors for readmission on multivariable analysis included perioperative blood transfusion (adjusted odds ratio [AOR] 1.33; 95% confidence interval [CI], 1.08 to 1.65; P = .008), discharge to a nursing facility (AOR 1.83; 95% CI, 1.41 to 2.39; P < .001), high illness severity based on All Patients Refined Diagnosis-Related Groups scoring (AOR 1.49; 95% CI, 1.21 to 1.84; P < .001), chronic renal failure (AOR 1.61; 95% CI, 1.13 to 2.29; P = .009), and comorbid drug abuse (AOR 2.19; 95% CI, 1.08 to 4.41; P = .029). Conclusions: Nearly 1 in 5 patients undergoing esophagectomy are readmitted within 30 days of discharge, at a median cost of $9660 per readmission. Pulmonary complications account for the greatest number of readmissions and the greatest total cost burden. Targeting the causes of readmission, especially pulmonary causes, may help significantly reduce the total morbidity and health care costs associated with esophagectomy.

Original languageEnglish (US)
Pages (from-to)185-193
Number of pages9
JournalAnnals of Thoracic Surgery
Volume109
Issue number1
DOIs
StatePublished - Jan 2020

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Esophagectomy
Costs and Cost Analysis
Odds Ratio
Confidence Intervals
Lung
Patient Readmission
Quality of Health Care
Diagnosis-Related Groups
Blood Transfusion
Health Care Costs
Chronic Kidney Failure
Substance-Related Disorders
Nursing
Logistic Models
Databases
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Nationwide Analysis of 30-Day Readmissions After Esophagectomy : Causes, Costs, and Risk Factors. / Goel, Nicholas J.; Iyengar, Amit; Kelly, John J.; Mavroudis, Constantine; Lancaster, Catherine; Williams, Noel N.; Dempsey, Daniel T.; Kucharczuk, John.

In: Annals of Thoracic Surgery, Vol. 109, No. 1, 01.2020, p. 185-193.

Research output: Contribution to journalArticle

Goel, NJ, Iyengar, A, Kelly, JJ, Mavroudis, C, Lancaster, C, Williams, NN, Dempsey, DT & Kucharczuk, J 2020, 'Nationwide Analysis of 30-Day Readmissions After Esophagectomy: Causes, Costs, and Risk Factors', Annals of Thoracic Surgery, vol. 109, no. 1, pp. 185-193. https://doi.org/10.1016/j.athoracsur.2019.08.035
Goel, Nicholas J. ; Iyengar, Amit ; Kelly, John J. ; Mavroudis, Constantine ; Lancaster, Catherine ; Williams, Noel N. ; Dempsey, Daniel T. ; Kucharczuk, John. / Nationwide Analysis of 30-Day Readmissions After Esophagectomy : Causes, Costs, and Risk Factors. In: Annals of Thoracic Surgery. 2020 ; Vol. 109, No. 1. pp. 185-193.
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abstract = "Background: Postsurgical readmissions are an increasingly scrutinized marker of health care quality. We sought to estimate the rate, risk factors, causes, and costs associated with readmissions after esophagectomy in a large, nationally representative cohort. Methods: We studied patients from the Nationwide Readmissions Database undergoing esophagectomy from 2010 to 2014. Data were collected on the prevalence and indications for readmission within 30 days as well as the hospital-, procedure-, and patient-level risk factors as determined by multivariable logistic regression. Results: Among 13,282 cases, the rate of 30-day readmission was 19.4{\%}, with the most common indications for readmission being pulmonary (20.6{\%}) and gastrointestinal complications (20{\%}). Median cost of readmission was $9660 (interquartile range, $5392 to $20,447), and pulmonary complications accounted for the greatest total cost burden at 25.8{\%} of all readmission-related costs. Independent risk factors for readmission on multivariable analysis included perioperative blood transfusion (adjusted odds ratio [AOR] 1.33; 95{\%} confidence interval [CI], 1.08 to 1.65; P = .008), discharge to a nursing facility (AOR 1.83; 95{\%} CI, 1.41 to 2.39; P < .001), high illness severity based on All Patients Refined Diagnosis-Related Groups scoring (AOR 1.49; 95{\%} CI, 1.21 to 1.84; P < .001), chronic renal failure (AOR 1.61; 95{\%} CI, 1.13 to 2.29; P = .009), and comorbid drug abuse (AOR 2.19; 95{\%} CI, 1.08 to 4.41; P = .029). Conclusions: Nearly 1 in 5 patients undergoing esophagectomy are readmitted within 30 days of discharge, at a median cost of $9660 per readmission. Pulmonary complications account for the greatest number of readmissions and the greatest total cost burden. Targeting the causes of readmission, especially pulmonary causes, may help significantly reduce the total morbidity and health care costs associated with esophagectomy.",
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AU - Mavroudis, Constantine

AU - Lancaster, Catherine

AU - Williams, Noel N.

AU - Dempsey, Daniel T.

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N2 - Background: Postsurgical readmissions are an increasingly scrutinized marker of health care quality. We sought to estimate the rate, risk factors, causes, and costs associated with readmissions after esophagectomy in a large, nationally representative cohort. Methods: We studied patients from the Nationwide Readmissions Database undergoing esophagectomy from 2010 to 2014. Data were collected on the prevalence and indications for readmission within 30 days as well as the hospital-, procedure-, and patient-level risk factors as determined by multivariable logistic regression. Results: Among 13,282 cases, the rate of 30-day readmission was 19.4%, with the most common indications for readmission being pulmonary (20.6%) and gastrointestinal complications (20%). Median cost of readmission was $9660 (interquartile range, $5392 to $20,447), and pulmonary complications accounted for the greatest total cost burden at 25.8% of all readmission-related costs. Independent risk factors for readmission on multivariable analysis included perioperative blood transfusion (adjusted odds ratio [AOR] 1.33; 95% confidence interval [CI], 1.08 to 1.65; P = .008), discharge to a nursing facility (AOR 1.83; 95% CI, 1.41 to 2.39; P < .001), high illness severity based on All Patients Refined Diagnosis-Related Groups scoring (AOR 1.49; 95% CI, 1.21 to 1.84; P < .001), chronic renal failure (AOR 1.61; 95% CI, 1.13 to 2.29; P = .009), and comorbid drug abuse (AOR 2.19; 95% CI, 1.08 to 4.41; P = .029). Conclusions: Nearly 1 in 5 patients undergoing esophagectomy are readmitted within 30 days of discharge, at a median cost of $9660 per readmission. Pulmonary complications account for the greatest number of readmissions and the greatest total cost burden. Targeting the causes of readmission, especially pulmonary causes, may help significantly reduce the total morbidity and health care costs associated with esophagectomy.

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