abstract
Highlights
- •Thirty-day readmission is a quality measure for patient care and Medicare-based reimbursement.
- •The readmission rate to an academic gynecologic oncology surgical service was 11%.
- •In patients requiring >1 night stay after surgery, a readmission rate of 20.9% was observed.
- •Readmissions were costly and associated with surgical, medical, and psychosocial risk factors.
Objectives
Thirty-day
readmission is used as a quality measure for patient care and
Medicare-based hospital reimbursement. The primary study objective was
to describe the 30-day readmission rate to an academic gynecologic
oncology service. Secondary objectives were to identify risk factors and
costs related to readmission.
Methods
This
was a retrospective, concurrent cohort study of all surgical admissions
to an academic, high volume gynecologic oncology service during a
two-year period (2013–2014). Data were collected on patient
demographics, medical comorbidities, psychosocial risk factors, and
results from a hospital discharge screening survey. Mixed logistic
regression was used to identify factors associated with 30-day
readmission and costs of readmission were assessed.
Results
During
the two-year study period, 1605 women underwent an index surgical
admission. Among this population, a total of 177 readmissions (11.0%) in
135 unique patients occurred. In a surgical subpopulation with >1
night stay, a readmission rate of 20.9% was observed. The mean interval
to readmission was 11.8 days (SD 10.7) and mean length of readmission
stay was 5.1 days (SD 5.0). Factors associated with readmission included
radical surgery for ovarian cancer (OR 2.87) or cervical cancer (OR
4.33), creation of an ostomy (OR 11.44), a Charlson score of ≥5
(OR 2.15), a language barrier (OR 3.36), a median household income in
the lowest quartile (OR 6.49), and a positive discharge screen (OR
2.85). The mean cost per readmission was $25,416 (SD $26,736), with the
highest costs associated with gastrointestinal complications at $32,432
(SD $32,148). The total readmission-related costs during the study
period were $4,523,959.
Conclusions
Readmissions
to a high volume gynecologic oncology service were costly and related
to radical surgery for ovarian and cervical cancer as well as to
medical, socioeconomic and psychosocial patient variables. These data
may inform interventional studies aimed at decreasing unplanned
readmissions in gynecologic oncology surgical populations.
Question of competency (re: ostomy (OR 11.44)??
ReplyDelete