TY  - BOOK
AU  - Al-Refaie, Waddah B
AU  - Colton, Scott
AU  - Huang, Chun Chih
AU  - Johnson, Lynt B
AU  - Potosky, Arnold L
AU  - Shara, Nawar M
TI  - Readmissions after major cancer surgery among older adults
SN  - 0039-6060
KW  - *Abdominal Neoplasms/su [Surgery]
KW  - *Patient Readmission/sn [Statistics & Numerical Data]
KW  - *Pelvic Neoplasms/su [Surgery]
KW  - *Thoracic Neoplasms/su [Surgery]
KW  - Age Factors
KW  - Aged
KW  - Aged, 80 and over
KW  - Baltimore
KW  - District of Columbia
KW  - Female
KW  - Humans
KW  - Length of Stay/sn [Statistics & Numerical Data]
KW  - Length of Stay/td [Trends]
KW  - Logistic Models
KW  - Male
KW  - Multivariate Analysis
KW  - Patient Readmission/td [Trends]
KW  - Postoperative Complications/th [Therapy]
KW  - Retrospective Studies
KW  - Risk Factors
KW  - Treatment Outcome
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Surgery/Transplantation
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - BACKGROUND: Decreasing readmissions has become a focus of emerging efforts to improve the quality and affordability of health care. However, little is known about reasons for readmissions after major cancer surgery in the expanding elderly population (>65 years) who are also at increased risk of adverse operative events. We sought to identify (1) the extent to which older age impacts readmissions and (2) factors predictive of 30- and 90-day readmissions after major cancer surgery among older adults; CONCLUSION: In this large, multihospital study of older adults, multiple morbidities, procedure type, greater number of complications, and the treating hospital predicted 30- and 90-day readmissions. These findings point toward the potential impact of hospital-level factors behind readmission. Our results also heighten the importance of assessing the influence of readmission on other important cancer care metrics, namely, patient-reported outcomes and the completion of adjuvant systemic therapies.Copyright � 2015 Elsevier Inc. All rights reserved; METHODS: We identified 2,797 older adults who underwent 1 of 7 types of major thoracic or abdominopelvic cancer surgery within a large multihospital system from 2003 to 2012. Multivariate logistic regression analyses were conducted to identify predictors of 30- and 90-day readmission controlling for covariates; RESULTS: Overall 30- and 90-day readmission rates were 16% and 24% with the majority of readmissions occurring within 15-days of discharge. Principal diagnoses of 30-day readmissions included gastrointestinal, pulmonary, and infections complications. The 30-day readmissions were associated with >2 comorbid conditions and >2 postoperative complications. Readmissions varied significantly according to cancer surgery type and across treating hospitals. Readmissions did not vary by increasing age. Factors associated with 90-day readmission were comparable to those observed at 30 days
UR  - http://dx.doi.org/10.1016/j.surg.2015.01.028
ER  -