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18: Unplanned thirty-day readmission rates as a quality measure: Risk factors and costs of readmission on a gynecologic oncology service

      Objectives

      The rate of unplanned 30-day hospital readmission after discharge is considered a quality measure across U.S. hospitals and impacts Medicare-based reimbursements for inpatient care. Our study objectives were to calculate the 30-day readmission rate to our gynecologic oncology (GON) service, to identify risk factors for readmission, and to determine related costs.

      Materials and Methods

      All admissions to a high volume, academic GON surgical service during a two-year study period (2013-2014) were queried. Minor surgical procedures were excluded. Patients (pts) requiring hospital readmission within 30 days of discharge were identified. Index admissions were compared for pts with and without readmission. Risk factors and costs of readmission were identified. GI disturbance was defined as high ostomy output, SBO, or ileus. Infection was defined as surgical site infection (SSI) including fever and/or leukocytosis. Data was collected on a diverse array of pt demographic and clinical variables, psychosocial factors and results of an institutional discharge screen survey (Table). Multiple logistic regression was used to identify factors associated with thirty-day readmission.

      Results

      A total of 1606 women underwent surgical admission to the GON service. A total of 178 readmissions (11.1%) were observed. The average readmission interval was 11.82 days and average length of stay was 5.16 days. The most common reasons for readmission were GI disturbance (43%) and SSI (30%). Factors correlated with readmission included ovarian cancer cytoreductive surgery (OR 2.33, 95% CI 1.23-4.35), creation of an ostomy (OR 7.67, 95% CI 2.99-19.69), and positive discharge screen (OR 3.1, 95% CI 1.48-6.5). The mean cost of each readmission was $25,415; the costs associated with readmission for a GI disturbance were the highest at $32,432. The total inpatient cost related to readmission was $4,523,959.

      Conclusion

      Readmission to a high volume gynecologic oncology service was most associated with cytoreductive surgery for ovarian cancer, ostomy-related complications and post-discharge complex patient care needs, as identified by institutional discharge screening surveys. The costs of readmission represent a substantial financial burden for hospitals. These data may inform intervention studies to improve the quality of cancer care and reduce health care costs.
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