Fragmentation of postoperative care after surgical management of ovarian cancer at 30 days and 90 days

Abstract

Abstract Background Fragmentation of care, wherein a patient is discharged from an index hospital and undergoes an unexpected readmission to a non-index hospital, is associated with increased risk of adverse outcomes. Fragmentation is not well characterized in ovarian cancer. Objective The objective of this study was to assess risk factors and outcomes associated with fragmentation of care among women who undergo surgical treatment of ovarian cancer. Study Design The Nationwide Readmission Database was used to identify all-cause 30-day and 90-day postoperative readmissions following surgical management of ovarian cancer between 2010-2014. Postoperative fragmentation was defined as readmission to a hospital other than the index hospital of the initial surgery. Multivariable regression analyses were used to identify predictors of fragmentation in both 30-day and 90-day readmissions. Similarly, multivariable models were developed to determine the association between fragmentation and mortality among women who were readmitted. Results A total of 10,445 patients (13.3%) were readmitted at 30-days and 14,124 patients (18.0%) were readmitted at 90-days. Of these, there was a 20.8% and 25.7% rate of postoperative care fragmentation for 30-day and 90-day readmissions, respectively. Patient risk factors associated with fragmented postoperative care included Medicare insurance, lower income quartiles, and non-routine discharge to facility. Hospital factors associated with decreased risk of fragmentation included operation at a metropolitan teaching hospital, and performance of extended procedures. Cost and length of stay for the readmission were similar among those who had fragmented and non-fragmented readmissions at both 30 and 90-days. While there was no association between mortality and fragmentation for patients readmitted within 30-days (OR=1.19; 95% CI, 0.93-1.51), patients who had a fragmented readmission at 90-days were 22% more likely to die than those readmitted at 90-days to their index hospital (OR=1.22; 95% CI, 1.00-1.49) Conclusion Fragmentation of care is common in women with ovarian cancer who require postoperative readmission. Fragmented postoperative care is associated with an increased risk of mortality among women readmitted within 90-days of surgery.