Non-index Hospital Readmissions Research Articles

Quantifying Nonindex Hospital Readmissions and Care Fragmentation after Major Urological Oncology Surgeries in a Nationally Representative Sample

We quantified the underestimation of hospital readmission rates that can occur with institutional databases and the incidence of care fragmentation among patients undergoing urological oncology procedures in a nationally representative database. The 2013 Nationwide Readmissions Database was queried for patients undergoing prostatectomy, cystectomy, nephroureterectomy, nephrectomy, partial nephrectomy and retroperitoneal lymph node dissection for urological malignancies. Nationally representative 30 and 90-day readmission and care fragmentation rates were calculated for all procedures. Readmission rates with and without nonindex hospital readmissions were compared with Pearson's chi-square test. Multivariable logistic regression models were used to identify predictors of care fragmentation at 90-day followup. For all surgical procedures readmission rates were consistently underestimated by 17% to 29% at 90-day followup. The rates of care fragmentation among readmitted patients were similar for all procedures, ranging from 24% to 34% at 90-day followup. Overall 1 in 4 readmitted patients would not be captured in institutional databases and 1 in 3 readmitted patients experienced care fragmentation. Multivariable models did not identify a predictor of care fragmentation that was consistent across all procedures. The high rate of underestimation of readmission rates across all urological oncology procedures highlights the importance of linking institutional and payer claims databases to provide more accurate estimates of perioperative outcomes and health care utilization. The high rate of care fragmentation across all procedures emphasizes the need for future efforts to understand the clinical relevance of care fragmentation in patients with urological malignancies, and to identify patients at risk along with potentially modifiable risk factors for care fragmentation.

Predictors of readmission to non-index hospitals after colorectal surgery

BackgroundAlthough a significant proportion of patients are readmitted to non-index hospitals after surgery, risk factors for non-index hospital readmission are not well defined. MethodsUsing the California Office of State Health Planning and Development database from 2008 to 2012, patients readmitted to index versus non-index hospitals after colorectal surgery were directly compared. Risk factors for non-index hospital readmission were assessed through logistic regression. ResultsAmong the 14,401 patients requiring readmission, 10,890 (75.6%) were readmitted to index hospitals, whereas 3,511 (24.4%) were readmitted to non-index hospitals. Patients readmitted to non-index hospitals were more likely to be men and have a greater Charlson comorbidity index, non-private insurance, longer initial length of stay, longer travel distance, and non-home discharge disposition. On multivariable logistic regression analysis, living ≥10 miles from the index hospital was strongly predictive of non-index hospital readmission (odds ratio, 1.8; 95% confidence interval, 1.63 to 2.00). ConclusionsApproximately 25% of readmissions after colorectal surgery will be to non-index hospitals. Risks factors include greater comorbidities, non-private health insurance, occurrence of an inpatient complication, longer length of stay, greater travel distance, and non-home discharge disposition.

MP24-18 THE IMPACT OF READMISSIONS TO SECONDARY HOSPITALS ON FAILURE-TO-RESCUE RATES FOLLOWING MAJOR UROLOGIC CANCER SURGERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2015MP24-18 THE IMPACT OF READMISSIONS TO SECONDARY HOSPITALS ON FAILURE-TO-RESCUE RATES FOLLOWING MAJOR UROLOGIC CANCER SURGERY Jasmir Nayak, Sarah Holt, Jonathan Wright, Atreya Dash, and John Gore Jasmir NayakJasmir Nayak More articles by this author , Sarah HoltSarah Holt More articles by this author , Jonathan WrightJonathan Wright More articles by this author , Atreya DashAtreya Dash More articles by this author , and John GoreJohn Gore More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1160AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urological cancer surgery is complex with some suggesting centralization of certain procedures in an effort to improve outcomes and reduce morbidity. Morbidity extends beyond the index surgery and can be further reduced by effective peri-operative complication management. Although outcomes vary among hospitals, part of this may be attributed to differences in the failure-to-rescue (FTR) complications. We examined FTR rates and compared those readmitted to their index surgery hospital with those readmitted to a secondary hospital. METHODS We accessed the Washington State Comprehensive Hospital Abstract Reporting System from 2009-2013. ICD-9 codes identified patients who underwent radical prostatectomy (RP), radical cystectomy (RC), partial nephrectomy (PN), radical nephrectomy (RN) and retroperitoneal lymph node dissection (RPLND) for malignancy. FTR in this analysis was defined as death following readmission within 90 days of the index surgery. Primary (PH) and secondary hospitals (SH) were defined using hospital identifiers linked to unique admissions. Multivariable logistic regression models were used to identify factors associated with FTR. RESULTS 11,536 patients underwent urologic cancer surgery, of whom 61% underwent RP, 22% RN, 10% PN, 6% RC and 1% RPLND. Overall, 10% (range: 6-37%) were readmitted within 90 days of surgery. 61% were readmitted to their PH, although this varied according to procedure type (57% readmitted to PH after RP, compared with 60% after RN, 65% after PN, 67% after RC and 83% after RPLND). The likelihood of readmission to the PH decreased with increasing hospital volume (p<0.0001). Overall FTR rate was 4%, ranging from 0% for RPLND to 6% for RN. The FTR rate when presenting to the PH was 1.5% compared with 6.6% at a SH (p=0.002). The most common readmission diagnoses were renal failure (24%), sepsis (10%), venothromboembolic event (9%) and pneumonia (8%). Controlling for age, sex, comorbidities and hospital volume, the readmission hospital was independently associated with FTR (OR 0.39, 95% CI 0.21-0.74 for PH versus SH). CONCLUSIONS Hospital readmissions within 90 days of major urologic cancer surgery are associated with a low FTR rate; however, patients readmitted to a SH experienced higher FTR than those readmitted to their original hospital. These findings may inform clinical decision-making around hospital transfers and aid future quality improvement initiatives to reduce the morbidity associated with complex urologic oncology surgeries. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChappidi M, Kates M, Stimson C, Johnson M, Pierorazio P and Bivalacqua T (2018) Causes, Timing, Hospital Costs and Perioperative Outcomes of Index vs Nonindex Hospital Readmissions after Radical Cystectomy: Implications for Regionalization of CareJournal of Urology, VOL. 197, NO. 2, (296-301), Online publication date: 1-Feb-2017.Lenis A and Chamie K (2018) Regionalization of Cystectomy: Importance of Care Coordination, Bundled Payments and Surgical OwnershipJournal of Urology, VOL. 197, NO. 2, (278-279), Online publication date: 1-Feb-2017. Volume 193Issue 4SApril 2015Page: e283-e284 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jasmir Nayak More articles by this author Sarah Holt More articles by this author Jonathan Wright More articles by this author Atreya Dash More articles by this author John Gore More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Early and Late Perioperative Outcomes Following Radical Cystectomy: 90-Day Readmissions, Morbidity and Mortality in a Contemporary Series

Radical cystectomy remains associated with significant morbidity. Most series report outcomes with relatively short-term followup that may underestimate the true magnitude of the procedure and many report length of hospital stay but ignore readmission rates. We analyzed the predictors of early (30 days or less), late (31 to 90 days) and cumulative 90-day hospital readmissions, as well as morbidity and mortality rates. We reviewed our prospectively collected database of 753 patients who underwent radical cystectomy for urothelial cancer between January 2001 and December 2007. We examined the relationship between clinical variables and readmission rates during the early, late and 90-day postoperative period, and reviewed mortality and perioperative morbidity rates. There were 200 (26.6%) patients readmitted in the first 90 days following radical cystectomy. Of these patients 148 (19.7%) were readmitted early, 81 (10.8%) were readmitted late, and 29 (3.9%) had an early and late readmission. Logistical regression revealed gender (OR 1.50, 95% CI 1.00-2.27, p = 0.05), age adjusted Charlson comorbidity index (OR 1.19, 95% CI 1.06-1.34, p = 0.003) and any postoperative complications before discharge home (OR 1.84, 95% CI 1.19-2.83, p = 0.006) as independent predictors of 90-day readmission. The 30 and 90-day mortality rates were 2.1% (16) and 6.9% (52), respectively. Readmission rates after radical cystectomy are significant, approaching 27% within the first 90 days. Gender and age adjusted Charlson comorbidity index were independent predictors providing preoperative information identifying patients more likely to require readmission or possibly to benefit from a longer initial hospital stay.