Clinicopathological characteristics and management of patients with early readmission to our surgical oncology clinic

Year 2022, Volume: 8 Issue: 5, 710 - 715, 04.09.2022

Mehmet Ali Çaparlar , Şeref Dokcu , Salim Demirci

https://doi.org/10.18621/eurj.1108263

Abstract

Objectives: This study aimed to discuss the frequency of early readmission to the hospital after discharge in our oncology clinic, clinicopathological features, and management of these patients in light of current literature.

Methods: The medical records of 237 early readmitted patients within 30 days of discharge in our clinic were retrospectively reviewed. The patients were categorized according to their first diagnosis, Eastern Cooperative Oncology Group (ECOG) performance status, demographic, clinicopathological characteristics, readmission reasons, first treatment type, postoperative complications, the time of application after discharge and the type of treatment after admission.

Results: The mean age of the patients was 58.45 years, 57.4% were female, and the mean readmission time after discharge was 11.54 days. The most common primary diagnosis was gastric cancer (35.9%), and the most common emergency pathology requiring hospitalization was ileus-subileus (45.1%). After readmission, 42.6% of the patients received medical treatment. 60% of the readmitted patients had postoperative complications before discharge. Patients who had postoperative complications during the first hospitalization were more likely to have major or minor interventions after readmission (p < 0.01). Admission with a diagnosis of bowel obstruction was associated with the probability of major intervention (p < 0.01). Patients with an ECOG performance score of ≥2 was more frequently administered medical treatment (p = 0.001). Patients admitted with the diagnosis of anastomotic leak/abscess had a higher probability of having postoperative complications (p = 0.001).

Conclusions: Readmissions are a concern for all healthcare providers, including comprehensive cancer centers. Recent health policies strive to reduce preventable admissions. Hence, we believe focusing on postoperative complications, and palliative care services is necessary.

Keywords

Surgical oncology, patient re-admission, complication, palliative care

References

• 1. Aslan EÇ, Ağırbaş İ. [The importance, types and risk factors of hospital readmission collective labour]. J Soc Secur 2018;8:173-93. [Article in Turkish]
• 2. Ashton CM, Del Junco DJ, Souchek J, Wray NP, Mansyur CL. The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. Med Care 1997;35:1044-59.
• 3. Gawlas I, Sethi M, Winner M, Ebelboym I, Lee JL, Schrope BA, et al. Readmission after pancreatic resection is not an appropriate measure of quality. Ann Surg Oncol 2013;20:1781-7.
• 4. Saunders ND, Nichols SD, Antiporda MA, Johnson K, Walker K, Nilsson R, et al. Examination of unplanned 30-day readmissions to a comprehensive cancer hospital. J Oncol Pract 2015;11:e177-81.
• 5. Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 2013;369:1134-42.
• 6. Acher AW, Squires MH, Fields RC, Poultsides GA, Schmidt C, Votanopoulos KI, et al. Readmission following gastric cancer resection: risk factors and survival. J Gastrointest Surg 2016;20:1284-94.
• 7. Hendren S, Morris AM, Zhang W, Dimick J. Early discharge and hospital readmission after colectomy for cancer. Dis Colon Rectum 2011;54:1362-7.
• 8. Guinier D, Mantion GA, Alves A, Kwiatkowski F, Slim K, Panis Y, et al. Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study. Dis Colon Rectum 2007;50:1316-23.
• 9. Wick EC, Shore AD, Hirose K, Ibrahim AM, Gearhart SL, Efron J, et al. Readmission rates and cost following colorectal surgery. Dis Colon Rectum 2011;54:1475-9.
• 10. Kwaan MR, Vogler SA, Sun MY, Sirany AME, Melton GB, Madoff RD, et al. Readmission after colorectal surgery is related to preoperative clinical conditions and major complications. Dis Colon Rectum 2013;56:1087-92.
• 11. Emick DM, Riall TS, Cameron JL, Winter JM, Lillembe KD, Coleman J, et al. Hospital readmission after pancreaticoduodenectomy. J Gastrointest Surg 2006;10:1243-53.
• 12. McPhee JT, Hill JS, Whalen GF,Zayaruzny M, Litwin DE, Sullivan ME, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246-53.
• 13. Halloran CM, Ghaneh P, Bosonnet L, Hartley MN, Sutton R, Neoptolemos JP. Complications of pancreatic cancer resection. Dig Surg 2002;19:138-46.
• 14. Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg 2012;215:322-30.
• 15. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani D, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 2005;242:326-43.
• 16. Guven DC, Ceylan F, Cakir IY, Cesmeci E, Sayinalp B, Yesilyurt B, et al. Evaluation of early unplanned readmissions and predisposing factors in an oncology clinic. Support Care Cancer 2021;29:4159-64.
• 17. Dobbins TA, Badgery-Parker T, Currow DC, Young JM. Assessing measures of comorbidity and functional status for risk adjustment to compare hospital performance for colorectal cancer surgery: a retrospective data-linkage study. BMC Med Inform Decis Mak 2015;15:55.
• 18. Reddy DM, Townsend CM, Kuo YF, Freeman JL, Goodwin JS, Riall TS. Readmission after pancreatectomy for pancreatic cancer in medicare patients. J Gastrointest Surg 2009;13:1963-74.