MedStar Authors catalog › Details for: Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery.
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Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery.

by Shara, Nawar M; Al-Refaie, Waddah B.
Citation: Journal of the American College of Surgeons. 222(5):780-789.e2, 2016 May.Journal: Journal of the American College of Surgeons.Published: 2016ISSN: 1072-7515.Full author list: Zheng C; Habermann EB; Shara NM; Langan RC; Hong Y; Johnson LB; Al-Refaie WB.UI/PMID: 27016905.Subject(s): Adolescent | Adult | Aged | California/ep [Epidemiology] | Digestive System Surgical Procedures/ae [Adverse Effects] | Female | *Hospital Mortality | Humans | Male | Middle Aged | Neoplasms/ep [Epidemiology] | *Neoplasms/su [Surgery] | Patient Discharge/sn [Statistics & Numerical Data] | *Patient Readmission/sn [Statistics & Numerical Data] | Pneumonectomy/ae [Adverse Effects] | Postoperative Complications | Prostatectomy/ae [Adverse Effects] | Risk Assessment | Time Factors | Young AdultInstitution(s): MedStar Health Research InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: J Am Coll Surg. 222(5):780-789.e2, 2016 May.Local Holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: Despite national emphasis on care coordination, little is known about how fragmentation affects cancer surgery outcomes. Our study examines a specific form of fragmentation in post-discharge care-readmission to a hospital different from the location of the operation-and evaluates its causes and consequences among patients readmitted after major cancer surgery.Abstract: STUDY DESIGN: We used the State Inpatient Database of California (2004 to 2011) to identify patients who had major cancer surgery and their subsequent readmissions. Logistic models were used to examine correlates of non-index readmissions and to assess associations between location of readmission and outcomes, measured by in-hospital mortality and repeated readmission.Abstract: RESULTS: Of 9,233 readmissions within 30 days of discharge after major cancer surgery, 20.0% occurred in non-index hospitals. Non-index readmissions were associated with emergency readmission (odds ratio [OR] = 2.63; 95% CI, 2.26-3.06), rural residence (OR = 1.81; 95% CI, 1.61-2.04), and extensive procedures (eg hepatectomy vs proctectomy; OR = 2.77; CI, 2.08-3.70). Mortality was higher during non-index readmissions than index readmissions independent of patient, procedure, and hospital factors (OR = 1.31; 95% CI, 1.03-1.66), but was mitigated by adjusting for conditions present at readmission (OR = 1.24; 95% CI, 0.98-1.58). Non-index readmission predicted higher odds of repeated readmission within 60 days of discharge from the first readmission (OR = 1.16; 95% CI, 1.02-1.32), independent of all covariates.Abstract: CONCLUSIONS: Non-index readmissions constitute a substantial proportion of all readmissions after major cancer surgery. They are associated with more repeated readmissions and can be caused by severe surgical complications and increased travel burden. Overcoming disadvantages of non-index readmissions represents an opportunity to improve outcomes for patients having major cancer surgery.Abstract: Copyright � 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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