Unplanned 30-day hospital readmission as a quality measure in gynecologic oncology

作者：Wilbur MaryAnn B; Mannschreck Diana B; Angarita Ana M; Matsuno Rayna K; Tanner Edward J; Stone Rebecca L; Levinson Kimberly L; Temkin Sarah M; Makary Martin A; Leung Curtis A; Deutschendorf Amy; Pronovost Peter J; Brown Amy; Fader Amanda N^*

来源：Gynecologic Oncology, 2016, 143(3): 604-610.

DOI：10.1016/j.ygyno.2016.09.020

• Hospital readmissions
• Gynecologic cancer surgery
• Health care costs

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 (OR 2.15), a language barrier (OR 336), 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.

• 出版日期2016-12