Background: Decreasing readmissions has become a focus of emerging efforts to improve the quality and affordability of health care. However, little is known about reasons for readmissions after major cancer surgery in the expanding elderly population (≥65 years) who are also at increased risk of adverse operative events. We sought to identify (1) the extent to which older age impacts readmissions and (2) factors predictive of 30- and 90-day readmissions after major cancer surgery among older adults.
Methods: We identified 2,797 older adults who underwent 1 of 7 types of major thoracic or abdominopelvic cancer surgery within a large multihospital system from 2003 to 2012. Multivariate logistic regression analyses were conducted to identify predictors of 30- and 90-day readmission controlling for covariates.
Results: Overall 30- and 90-day readmission rates were 16% and 24% with the majority of readmissions occurring within 15-days of discharge. Principal diagnoses of 30-day readmissions included gastrointestinal, pulmonary, and infections complications. The 30-day readmissions were associated with >2 comorbid conditions and ≥2 postoperative complications. Readmissions varied significantly according to cancer surgery type and across treating hospitals. Readmissions did not vary by increasing age. Factors associated with 90-day readmission were comparable to those observed at 30 days.
Conclusion: In this large, multihospital study of older adults, multiple morbidities, procedure type, greater number of complications, and the treating hospital predicted 30- and 90-day readmissions. These findings point toward the potential impact of hospital-level factors behind readmission. Our results also heighten the importance of assessing the influence of readmission on other important cancer care metrics, namely, patient-reported outcomes and the completion of adjuvant systemic therapies.
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