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

doi:10.1016/j.jtcvs.2015.01.064

Why are patients being readmitted after surgery for esophageal cancer?

J Thorac Cardiovasc Surg. 2015 May;149(5):1384-9; discussion 1389-91. doi: 10.1016/j.jtcvs.2015.01.064. Epub 2015 Feb 11.

Authors

Sneha P Shah¹, Tim Xu¹, Craig M Hooker¹, Alicia Hulbert², Richard J Battafarano¹, Malcolm V Brock³, Benedetto Mungo¹, Daniela Molena¹, Stephen C Yang⁴

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
² Division of Cancer Biology, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Md.
³ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md; Division of Cancer Biology, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Md.
⁴ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md. Electronic address: syang7@jhmi.edu.

PMID: 25983251
DOI: 10.1016/j.jtcvs.2015.01.064

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.

Keywords: Thirty-day readmission; esophageal cancer; length of stay; multimodality therapy; neoadjuvant chemoradiation plus surgery; outcomes; postoperative complications.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Baltimore
Chemoradiotherapy, Adjuvant
Chi-Square Distribution
Esophageal Neoplasms / mortality
Esophageal Neoplasms / pathology
Esophageal Neoplasms / surgery*
Esophagectomy / adverse effects*
Esophagectomy / mortality
Female
Hospital Mortality
Humans
Length of Stay
Logistic Models
Male
Middle Aged
Multivariate Analysis
Neoadjuvant Therapy
Odds Ratio
Patient Discharge
Patient Readmission*
Postoperative Complications / etiology*
Postoperative Complications / mortality
Postoperative Complications / therapy
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome