Readmission Adversely Affects Survival in Surgical Rectal Cancer Patients

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Abstract

Background: Readmission has received attention as a potential healthcare quality metric. No studies have investigated the relationship between readmission and survival in patients undergoing rectal cancer surgery. The aims of this study were to identify factors associated with 30-day readmission after rectal cancer surgery and to determine the impact of readmission on overall survival (OS). Methods: Patients who underwent surgical treatment for rectal/rectosigmoid adenocarcinoma stages I–IV were identified using the National Cancer Database (2004–2014). Multivariable logistic regression was used to identify factors for readmission. 2:1 nearest neighbor caliper matching without replacement was used to ensure similarity of patients being compared. Survival analyses were performed using Kaplan–Meier method along with log-rank test and Cox proportional hazards model. Results: Of 110,167 patients, 7045 (6.39%) were readmitted. Factors associated with readmission included higher Charlson comorbidity score, non-private or no insurance, procedure type, hospitals in the Northeast, South, and Midwest regions, and prolonged length of stay. Within the matched cohort (13,756 non-readmitted and 6878 readmitted), readmitted patients had worse 5- and 10-year OS regardless of cancer stage (p < 0.001) and procedure type. Five- and 10-year OS were 58.98% and 41.01% for readmitted patients, 64.96% and 43.50% for non-readmitted patients. Readmitted patients had shorter OS by 13.14 months and increased risk of mortality (HR 1.20, 95% CI 1.15–1.25, p < 0.001). Conclusions: Thirty-day readmission after rectal cancer surgery is associated with decreased OS. Efforts to reduce readmissions should be considered to advance cancer care and enhance the potential for improved patient survival.

Original languageEnglish (US)
JournalWorld journal of surgery
DOIs
StatePublished - Jan 1 2019

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Rectal Neoplasms
Survival
Neoplasms
Quality of Health Care
Survival Analysis
Insurance
Proportional Hazards Models
Comorbidity
Length of Stay
Adenocarcinoma
Logistic Models
Databases
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

@article{6beec0ab1bab4dbaa1fea82cf1bbe638,
title = "Readmission Adversely Affects Survival in Surgical Rectal Cancer Patients",
abstract = "Background: Readmission has received attention as a potential healthcare quality metric. No studies have investigated the relationship between readmission and survival in patients undergoing rectal cancer surgery. The aims of this study were to identify factors associated with 30-day readmission after rectal cancer surgery and to determine the impact of readmission on overall survival (OS). Methods: Patients who underwent surgical treatment for rectal/rectosigmoid adenocarcinoma stages I–IV were identified using the National Cancer Database (2004–2014). Multivariable logistic regression was used to identify factors for readmission. 2:1 nearest neighbor caliper matching without replacement was used to ensure similarity of patients being compared. Survival analyses were performed using Kaplan–Meier method along with log-rank test and Cox proportional hazards model. Results: Of 110,167 patients, 7045 (6.39{\%}) were readmitted. Factors associated with readmission included higher Charlson comorbidity score, non-private or no insurance, procedure type, hospitals in the Northeast, South, and Midwest regions, and prolonged length of stay. Within the matched cohort (13,756 non-readmitted and 6878 readmitted), readmitted patients had worse 5- and 10-year OS regardless of cancer stage (p < 0.001) and procedure type. Five- and 10-year OS were 58.98{\%} and 41.01{\%} for readmitted patients, 64.96{\%} and 43.50{\%} for non-readmitted patients. Readmitted patients had shorter OS by 13.14 months and increased risk of mortality (HR 1.20, 95{\%} CI 1.15–1.25, p < 0.001). Conclusions: Thirty-day readmission after rectal cancer surgery is associated with decreased OS. Efforts to reduce readmissions should be considered to advance cancer care and enhance the potential for improved patient survival.",
author = "Chen, {Sophia Y.} and Miloslawa Stem and Gearhart, {Susan L} and Bashar Safar and Fang, {Sandy H} and Nilofer Azad and Adrian Murphy and Amol Narang and Christopher Wolfgang and Jonathan Efron",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00268-019-05053-4",
language = "English (US)",
journal = "World Journal of Surgery",
issn = "0364-2313",
publisher = "Springer New York",

}

TY - JOUR

T1 - Readmission Adversely Affects Survival in Surgical Rectal Cancer Patients

AU - Chen, Sophia Y.

AU - Stem, Miloslawa

AU - Gearhart, Susan L

AU - Safar, Bashar

AU - Fang, Sandy H

AU - Azad, Nilofer

AU - Murphy, Adrian

AU - Narang, Amol

AU - Wolfgang, Christopher

AU - Efron, Jonathan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Readmission has received attention as a potential healthcare quality metric. No studies have investigated the relationship between readmission and survival in patients undergoing rectal cancer surgery. The aims of this study were to identify factors associated with 30-day readmission after rectal cancer surgery and to determine the impact of readmission on overall survival (OS). Methods: Patients who underwent surgical treatment for rectal/rectosigmoid adenocarcinoma stages I–IV were identified using the National Cancer Database (2004–2014). Multivariable logistic regression was used to identify factors for readmission. 2:1 nearest neighbor caliper matching without replacement was used to ensure similarity of patients being compared. Survival analyses were performed using Kaplan–Meier method along with log-rank test and Cox proportional hazards model. Results: Of 110,167 patients, 7045 (6.39%) were readmitted. Factors associated with readmission included higher Charlson comorbidity score, non-private or no insurance, procedure type, hospitals in the Northeast, South, and Midwest regions, and prolonged length of stay. Within the matched cohort (13,756 non-readmitted and 6878 readmitted), readmitted patients had worse 5- and 10-year OS regardless of cancer stage (p < 0.001) and procedure type. Five- and 10-year OS were 58.98% and 41.01% for readmitted patients, 64.96% and 43.50% for non-readmitted patients. Readmitted patients had shorter OS by 13.14 months and increased risk of mortality (HR 1.20, 95% CI 1.15–1.25, p < 0.001). Conclusions: Thirty-day readmission after rectal cancer surgery is associated with decreased OS. Efforts to reduce readmissions should be considered to advance cancer care and enhance the potential for improved patient survival.

AB - Background: Readmission has received attention as a potential healthcare quality metric. No studies have investigated the relationship between readmission and survival in patients undergoing rectal cancer surgery. The aims of this study were to identify factors associated with 30-day readmission after rectal cancer surgery and to determine the impact of readmission on overall survival (OS). Methods: Patients who underwent surgical treatment for rectal/rectosigmoid adenocarcinoma stages I–IV were identified using the National Cancer Database (2004–2014). Multivariable logistic regression was used to identify factors for readmission. 2:1 nearest neighbor caliper matching without replacement was used to ensure similarity of patients being compared. Survival analyses were performed using Kaplan–Meier method along with log-rank test and Cox proportional hazards model. Results: Of 110,167 patients, 7045 (6.39%) were readmitted. Factors associated with readmission included higher Charlson comorbidity score, non-private or no insurance, procedure type, hospitals in the Northeast, South, and Midwest regions, and prolonged length of stay. Within the matched cohort (13,756 non-readmitted and 6878 readmitted), readmitted patients had worse 5- and 10-year OS regardless of cancer stage (p < 0.001) and procedure type. Five- and 10-year OS were 58.98% and 41.01% for readmitted patients, 64.96% and 43.50% for non-readmitted patients. Readmitted patients had shorter OS by 13.14 months and increased risk of mortality (HR 1.20, 95% CI 1.15–1.25, p < 0.001). Conclusions: Thirty-day readmission after rectal cancer surgery is associated with decreased OS. Efforts to reduce readmissions should be considered to advance cancer care and enhance the potential for improved patient survival.

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U2 - 10.1007/s00268-019-05053-4

DO - 10.1007/s00268-019-05053-4

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JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

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