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Comparison of Rates and Outcomes of Readmission to Index vs Nonindex Hospitals After Major Cancer Surgery.
JAMA Surg 2018; 153(8):719-727JS

Abstract

Importance

Increasing regionalization of cancer surgery has the inadvertent potential to lead to fragmentation of care if readmissions occur at a facility other than the index hospital. The magnitude and adverse effects of readmission to a facility other than the one where the surgery was performed are unclear.

Objectives

To assess rates of readmission to nonindex hospitals after major cancer surgery and to compare outcomes between index and nonindex hospital readmissions.

Design, Setting, and Participants

In this multicenter, population-based, nationally representative study of adult patients undergoing a major cancer operation (defined as esophagectomies or gastrectomies, hepaticobiliary resections, pancreatectomies, colorectal resections, or cystectomies), retrospective analyses were performed using the Nationwide Readmissions Database (admissions from January 1 through September 30, 2013). Descriptive analyses were performed to determine 90-day readmission characteristics, including timing, cost, and outcomes. Adjusting for clustering by facility, the study used multivariate logistic regression to identify factors associated with nonindex vs index readmissions. The study also used regression models to identify differences in mortality, major complications, and subsequent readmissions between the 2 groups. Data analysis was performed from January 1 through December 31, 2013.

Exposures

Readmission to index vs nonindex hospitals (defined as any hospital other than the hospital where the major cancer operation was performed).

Main Outcomes and Measures

Proportion of 90-day readmissions and nonindex readmissions after major cancer surgery, factors associated with nonindex readmissions, and difference between in-hospital mortality, hospital costs, and subsequent readmissions for patients admitted to index vs nonindex hospitals.

Results

A total of 60 970 patients were included in the study (mean [SD] age, 67 [13] years; 7619 [55.6%] male and 6075 [44.4%] female). The 90-day readmission rate was 23.0%. Of the 13 695 first readmissions, 20.1% were to a nonindex hospital. Independent factors associated with readmission to a nonindex hospital included type of procedure, comorbidities (OR, 1.40; 95% CI, 1.15-1.70), elective admission (OR, 1.21; 95% CI, 1.06-1.37), discharge to a nursing facility (OR, 1.20; 95% CI, 1.07-1.36), and surgery at a teaching hospital (OR, 1.16; 95% CI, 1.00-1.34) (all P < .05). After risk adjustment, patients readmitted to nonindex hospitals had 31.2% higher odds of mortality (odds ratio, 1.31; 95% CI, 1.05-1.64) and 27.3% higher odds of having a major complication (odds ratio, 1.27; 95% CI, 1.14-1.42). Subsequent readmissions and hospital costs were not different between the 2 groups.

Conclusions and Relevance

Approximately one-fifth of readmissions were to a nonindex hospital and were associated with higher mortality and morbidity than readmission to index hospitals. Factors that influence nonindex readmissions have been identified to target interventions.

Authors+Show Affiliations

Department of Surgery, Howard University Hospital, Washington, DC.Department of Surgery, Howard University Hospital, Washington, DC.Department of Applied Economics, Purdue University, West Lafayette, Indiana.Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California.Department of Surgery, Howard University Hospital, Washington, DC.Department of Surgery, Mayo Clinic, Phoenix, Arizona.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29641833

Citation

Zafar, Syed Nabeel, et al. "Comparison of Rates and Outcomes of Readmission to Index Vs Nonindex Hospitals After Major Cancer Surgery." JAMA Surgery, vol. 153, no. 8, 2018, pp. 719-727.
Zafar SN, Shah AA, Channa H, et al. Comparison of Rates and Outcomes of Readmission to Index vs Nonindex Hospitals After Major Cancer Surgery. JAMA Surg. 2018;153(8):719-727.
Zafar, S. N., Shah, A. A., Channa, H., Raoof, M., Wilson, L., & Wasif, N. (2018). Comparison of Rates and Outcomes of Readmission to Index vs Nonindex Hospitals After Major Cancer Surgery. JAMA Surgery, 153(8), pp. 719-727. doi:10.1001/jamasurg.2018.0380.
Zafar SN, et al. Comparison of Rates and Outcomes of Readmission to Index Vs Nonindex Hospitals After Major Cancer Surgery. JAMA Surg. 2018 08 1;153(8):719-727. PubMed PMID: 29641833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Rates and Outcomes of Readmission to Index vs Nonindex Hospitals After Major Cancer Surgery. AU - Zafar,Syed Nabeel, AU - Shah,Adil A, AU - Channa,Hira, AU - Raoof,Mustafa, AU - Wilson,Lori, AU - Wasif,Nabil, PY - 2018/4/12/pubmed PY - 2018/4/12/medline PY - 2018/4/12/entrez SP - 719 EP - 727 JF - JAMA surgery JO - JAMA Surg VL - 153 IS - 8 N2 - Importance: Increasing regionalization of cancer surgery has the inadvertent potential to lead to fragmentation of care if readmissions occur at a facility other than the index hospital. The magnitude and adverse effects of readmission to a facility other than the one where the surgery was performed are unclear. Objectives: To assess rates of readmission to nonindex hospitals after major cancer surgery and to compare outcomes between index and nonindex hospital readmissions. Design, Setting, and Participants: In this multicenter, population-based, nationally representative study of adult patients undergoing a major cancer operation (defined as esophagectomies or gastrectomies, hepaticobiliary resections, pancreatectomies, colorectal resections, or cystectomies), retrospective analyses were performed using the Nationwide Readmissions Database (admissions from January 1 through September 30, 2013). Descriptive analyses were performed to determine 90-day readmission characteristics, including timing, cost, and outcomes. Adjusting for clustering by facility, the study used multivariate logistic regression to identify factors associated with nonindex vs index readmissions. The study also used regression models to identify differences in mortality, major complications, and subsequent readmissions between the 2 groups. Data analysis was performed from January 1 through December 31, 2013. Exposures: Readmission to index vs nonindex hospitals (defined as any hospital other than the hospital where the major cancer operation was performed). Main Outcomes and Measures: Proportion of 90-day readmissions and nonindex readmissions after major cancer surgery, factors associated with nonindex readmissions, and difference between in-hospital mortality, hospital costs, and subsequent readmissions for patients admitted to index vs nonindex hospitals. Results: A total of 60 970 patients were included in the study (mean [SD] age, 67 [13] years; 7619 [55.6%] male and 6075 [44.4%] female). The 90-day readmission rate was 23.0%. Of the 13 695 first readmissions, 20.1% were to a nonindex hospital. Independent factors associated with readmission to a nonindex hospital included type of procedure, comorbidities (OR, 1.40; 95% CI, 1.15-1.70), elective admission (OR, 1.21; 95% CI, 1.06-1.37), discharge to a nursing facility (OR, 1.20; 95% CI, 1.07-1.36), and surgery at a teaching hospital (OR, 1.16; 95% CI, 1.00-1.34) (all P < .05). After risk adjustment, patients readmitted to nonindex hospitals had 31.2% higher odds of mortality (odds ratio, 1.31; 95% CI, 1.05-1.64) and 27.3% higher odds of having a major complication (odds ratio, 1.27; 95% CI, 1.14-1.42). Subsequent readmissions and hospital costs were not different between the 2 groups. Conclusions and Relevance: Approximately one-fifth of readmissions were to a nonindex hospital and were associated with higher mortality and morbidity than readmission to index hospitals. Factors that influence nonindex readmissions have been identified to target interventions. SN - 2168-6262 UR - https://www.unboundmedicine.com/medline/citation/29641833/Comparison_of_Rates_and_Outcomes_of_Readmission_to_Index_vs_Nonindex_Hospitals_After_Major_Cancer_Surgery_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2018.0380 DB - PRIME DP - Unbound Medicine ER -