An evaluation of patterns and outcomes associated with postsurgical hospital readmissions in patients with hepatopancreatobiliary (HPB) or gastric cancer found that travel distance and timing determine likelihood of care fragmentation for these patients. The findings were published in the Journal of the American College of Surgeons.
The study included patients from California, New York, and Florida who were identified from the database of the Healthcare Cost and Utilization Project. Patients had undergone surgical procedures for HPB or gastric cancer, and they were followed for 90 days following discharge after the index surgery.
Of 31,526 patients included in the study, 7536 (24%) were readmitted to hospitals during the 90 days following the index surgery. Among these readmitted patients, 28% had been readmitted to outside hospitals, with an outside hospital being one other than the hospital where the index surgery occurred.
The mortality rate for patients seen at outside hospitals was higher (8.0%) than it was for patients readmitted to the index surgical hospital (5.4%; odds ratio, 1.5; P <.001).
Readmissions at outside hospitals tended to occur later during the study period, at a median of 25 days following discharge, compared with 12 days for index surgical hospital readmissions (P <.001). Analyses of zip code data also suggested that hospital proximity was a factor significantly associated with readmission to an outside hospital or the index surgical hospital.
The researchers noted that the factors of distance from index hospital and time from discharge were not linked to mortality with readmission. However, surgical complications that were treated at an outside hospital did show a link to readmission mortality, compared with treatment at the index hospital (P <.001). Readmission at hospitals with lower annual frequencies of HPB or gastric surgeries appeared associated with mortality in a univariate analysis, but a risk-adjusted analysis showed the relationship to not be significant (P =.226).
“After HPB and gastric oncologic surgery, readmission to an outside hospital is a frequent occurrence and is associated with worse mortality,” the researchers concluded in their report. They recommended that healthcare providers identify at-risk patients and develop plans to address postoperative treatment needs.
Brauer DG, Wu N, Keller MR, et al. Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database. J Am Coll Surg. Published online March 24, 2021. doi:10.1016/j.jamcollsurg.2021.03.017