Why are patients being readmitted after surgery for esophageal cancer?

Sneha P. Shah, Tim Xu, Craig M. Hooker, Alicia Hulbert, Richard J Battafarano, Malcolm V Brock, Benedetto Mungo, Daniela Molena, Stephen C Yang

Research output: Contribution to journalArticle

Abstract

Objective Readmission after surgery is an unwanted adverse event that is costly to the healthcare system. We sought to evaluate factors associated with increased risk of readmission and to characterize the nature of these readmissions in patients who have esophageal cancer. Methods A retrospective cohort study was performed in 306 patients with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by esophagectomy at Johns Hopkins Hospital between 1993 and 2011. Logistic regression was used to identify factors associated with 30-day readmission. Readmissions were defined as inpatient admissions to our institution within 30 days of discharge. Results The median age at surgery was 61 years; the median postoperative length of stay was 9 days; and 48% of patients had ≥1 postoperative complication (POC). The 30-day readmission rate was 13.7% (42 of 306). In univariate analysis, length of stay and having ≥1 POC were significantly associated with readmission. In multivariate analysis, having ≥1 POC was significantly associated with a >2-fold increase in risk for 30-day readmission (odds ratio 2.35, with 95% confidence interval [1.08-5.09], P = .031) when controlling for age at diagnosis and length of stay. Of the 42 patients who were readmitted, 67% experienced POCs after surgery; 50% of patients who experienced POCs were readmitted for reasons related to their postoperative complication. The most common reasons for readmission were pulmonary issues (29%), anastomotic complications (20%), gastrointestinal concerns (17%), and venous thromboembolism (14%). Conclusions Complications not adequately managed before discharge may lead to readmission. Quality improvement efforts surrounding venous thromboembolism prophylaxis, and discharging patients nothing-by-mouth, may be warranted.

Original languageEnglish (US)
Article number9366
Pages (from-to)1384-1391
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume149
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Esophageal Neoplasms
Length of Stay
Venous Thromboembolism
Patient Readmission
Esophagectomy
Quality Improvement
Mouth
Inpatients
Cohort Studies
Multivariate Analysis
Retrospective Studies
Logistic Models
Odds Ratio
Confidence Intervals
Carcinoma
Delivery of Health Care
Lung

Keywords

  • Esophageal cancer
  • Length of stay
  • Multimodality therapy
  • Neoadjuvant chemoradiation plus surgery
  • Outcomes
  • Postoperative complications
  • Thirty-day readmission

ASJC Scopus subject areas

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

Cite this

Why are patients being readmitted after surgery for esophageal cancer? / Shah, Sneha P.; Xu, Tim; Hooker, Craig M.; Hulbert, Alicia; Battafarano, Richard J; Brock, Malcolm V; Mungo, Benedetto; Molena, Daniela; Yang, Stephen C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 149, No. 5, 9366, 01.05.2015, p. 1384-1391.

Research output: Contribution to journalArticle

Shah, Sneha P. ; Xu, Tim ; Hooker, Craig M. ; Hulbert, Alicia ; Battafarano, Richard J ; Brock, Malcolm V ; Mungo, Benedetto ; Molena, Daniela ; Yang, Stephen C. / Why are patients being readmitted after surgery for esophageal cancer?. In: Journal of Thoracic and Cardiovascular Surgery. 2015 ; Vol. 149, No. 5. pp. 1384-1391.
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title = "Why are patients being readmitted after surgery for esophageal cancer?",
abstract = "Objective Readmission after surgery is an unwanted adverse event that is costly to the healthcare system. We sought to evaluate factors associated with increased risk of readmission and to characterize the nature of these readmissions in patients who have esophageal cancer. Methods A retrospective cohort study was performed in 306 patients with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by esophagectomy at Johns Hopkins Hospital between 1993 and 2011. Logistic regression was used to identify factors associated with 30-day readmission. Readmissions were defined as inpatient admissions to our institution within 30 days of discharge. Results The median age at surgery was 61 years; the median postoperative length of stay was 9 days; and 48{\%} of patients had ≥1 postoperative complication (POC). The 30-day readmission rate was 13.7{\%} (42 of 306). In univariate analysis, length of stay and having ≥1 POC were significantly associated with readmission. In multivariate analysis, having ≥1 POC was significantly associated with a >2-fold increase in risk for 30-day readmission (odds ratio 2.35, with 95{\%} confidence interval [1.08-5.09], P = .031) when controlling for age at diagnosis and length of stay. Of the 42 patients who were readmitted, 67{\%} experienced POCs after surgery; 50{\%} of patients who experienced POCs were readmitted for reasons related to their postoperative complication. The most common reasons for readmission were pulmonary issues (29{\%}), anastomotic complications (20{\%}), gastrointestinal concerns (17{\%}), and venous thromboembolism (14{\%}). Conclusions Complications not adequately managed before discharge may lead to readmission. Quality improvement efforts surrounding venous thromboembolism prophylaxis, and discharging patients nothing-by-mouth, may be warranted.",
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AU - Xu, Tim

AU - Hooker, Craig M.

AU - Hulbert, Alicia

AU - Battafarano, Richard J

AU - Brock, Malcolm V

AU - Mungo, Benedetto

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AU - Yang, Stephen C

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N2 - Objective Readmission after surgery is an unwanted adverse event that is costly to the healthcare system. We sought to evaluate factors associated with increased risk of readmission and to characterize the nature of these readmissions in patients who have esophageal cancer. Methods A retrospective cohort study was performed in 306 patients with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by esophagectomy at Johns Hopkins Hospital between 1993 and 2011. Logistic regression was used to identify factors associated with 30-day readmission. Readmissions were defined as inpatient admissions to our institution within 30 days of discharge. Results The median age at surgery was 61 years; the median postoperative length of stay was 9 days; and 48% of patients had ≥1 postoperative complication (POC). The 30-day readmission rate was 13.7% (42 of 306). In univariate analysis, length of stay and having ≥1 POC were significantly associated with readmission. In multivariate analysis, having ≥1 POC was significantly associated with a >2-fold increase in risk for 30-day readmission (odds ratio 2.35, with 95% confidence interval [1.08-5.09], P = .031) when controlling for age at diagnosis and length of stay. Of the 42 patients who were readmitted, 67% experienced POCs after surgery; 50% of patients who experienced POCs were readmitted for reasons related to their postoperative complication. The most common reasons for readmission were pulmonary issues (29%), anastomotic complications (20%), gastrointestinal concerns (17%), and venous thromboembolism (14%). Conclusions Complications not adequately managed before discharge may lead to readmission. Quality improvement efforts surrounding venous thromboembolism prophylaxis, and discharging patients nothing-by-mouth, may be warranted.

AB - Objective Readmission after surgery is an unwanted adverse event that is costly to the healthcare system. We sought to evaluate factors associated with increased risk of readmission and to characterize the nature of these readmissions in patients who have esophageal cancer. Methods A retrospective cohort study was performed in 306 patients with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by esophagectomy at Johns Hopkins Hospital between 1993 and 2011. Logistic regression was used to identify factors associated with 30-day readmission. Readmissions were defined as inpatient admissions to our institution within 30 days of discharge. Results The median age at surgery was 61 years; the median postoperative length of stay was 9 days; and 48% of patients had ≥1 postoperative complication (POC). The 30-day readmission rate was 13.7% (42 of 306). In univariate analysis, length of stay and having ≥1 POC were significantly associated with readmission. In multivariate analysis, having ≥1 POC was significantly associated with a >2-fold increase in risk for 30-day readmission (odds ratio 2.35, with 95% confidence interval [1.08-5.09], P = .031) when controlling for age at diagnosis and length of stay. Of the 42 patients who were readmitted, 67% experienced POCs after surgery; 50% of patients who experienced POCs were readmitted for reasons related to their postoperative complication. The most common reasons for readmission were pulmonary issues (29%), anastomotic complications (20%), gastrointestinal concerns (17%), and venous thromboembolism (14%). Conclusions Complications not adequately managed before discharge may lead to readmission. Quality improvement efforts surrounding venous thromboembolism prophylaxis, and discharging patients nothing-by-mouth, may be warranted.

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KW - Length of stay

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KW - Outcomes

KW - Postoperative complications

KW - Thirty-day readmission

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