Publication Abstract

Authors: Hu Y, McMurry TL, Stukenborg GJ, Kozower BD

Title: Readmission predicts 90-day mortality after esophagectomy: Analysis of Surveillance, Epidemiology, and End Results Registry linked to Medicare outcomes.

Journal: J Thorac Cardiovasc Surg 150(5):1254-60

Date: 2015 Nov

Abstract: OBJECTIVES: Postoperative readmission is an increasingly scrutinized quality metric that affects patient satisfaction and cost. Even more important is its implication for short-term prognosis. The purpose of this study is to characterize postesophagectomy readmissions and determine their relationship with subsequent 90-day mortality. METHODS: Data were extracted for esophagectomy patients from the linked SEER-Medicare Registry (2000-2009), which provides longitudinal information about Medicare beneficiaries who have cancer. We assessed demographics, comorbidities, 30-day readmission, and 90-day mortality. Readmitting facility and diagnoses were identified. A hierarchic multivariable regression model clustered at the hospital level assessed the relationship between readmission within 30 days of discharge and 90-day mortality. RESULTS: We identified 1543 patients discharged alive after esophagectomy. Among patients discharged alive, the readmission rate was 319 of 1543 (20.7%); 107 of 319 (33.5%) readmissions were to facilities that did not perform the index operation. Mortality rate at 90 days among patients discharged alive was 98 of 1543 (6.4%). Readmission was associated with a 4-fold increase in mortality (16.3% vs 3.8%, P < .001). Using multivariable regression, readmission was the strongest predictor of mortality (odds ratio 6.64, P < .001), with a stronger association than age, Charlson score, and index length of stay. Readmission diagnoses with the highest mortality rates were those associated with pulmonary, gastrointestinal, and cardiovascular diagnoses. CONCLUSIONS: Patients readmitted within 30 days of discharge after esophagectomy are at exceptionally high risk for early mortality. Early recognition of life-threatening readmission diagnoses is essential to providing optimal care.