Risk factors identified for rehospitalization among esophagectomy patients

Approximately one in five esophagectomy patients have an unplanned rehospitalization, and risk factors associated with readmission include longer operations, postoperative ICU admission and blood transfusion near time of surgery, according to study data presented at the American Association for Thoracic Surgery Annual Meeting in Baltimore.

“These findings will allow surgeons to identify frail patients using preoperative scoring systems to try to ensure that patients are as healthy as possible before surgery and reduce the likelihood of ICU stay,” Stephen D. Cassivi, MD MSc, thoracic surgeon from the Mayo Clinic in Rochester, Minn., said in a press release. “Complicated surgery may be associated with more blood loss and, therefore, should be carefully planned and carried out.”

Seeking to identify modifiable risk factors associated with hospital readmissions after esophagectomy, Cassivi and colleagues contacted all 107 patients who underwent elective esophagectomy from August 2013 through July 2014 to determine if they had been rehospitalized within 30 days of their initial discharge at Mayo Clinic. They also collected supplementary demographic data from their prospectively maintained database.

“Careful collection of data regarding patient outcomes, including unplanned hospital readmissions, is essential to improve the quality of patient care since national databases can leave gaps in data regarding follow up of these patients by failing to identify all readmissions or emergency department visits patients may make after their surgery,” Karen J. Dickinson, MD, also from the Mayo Clinic, said in the press release.

Among the 84 patients who met inclusion criteria (median age, 75 years; mostly men), 72% underwent transthoracic esophagectomy, 7% underwent a minimally invasive procedure, 2% died within 30 days and 8% had an anastomotic leak.

Notably, 19% had an unplanned rehospitalization within 30 days (88% at Mayo Clinic, 12% at other institutions). Median length of stay was 15 days for patients with an unplanned readmission vs. 11 days for patients without an unplanned readmission, but this did not reach statistical significance.

The median interval between discharge and readmission was 7 days, and the median length of readmission was 4.5 days. Pulmonary (44%) and GI complications (36%; including anastomotic complications) were the most common reasons for readmission.

They found that length of procedure (P < .01), postoperative ICU admission (P = .02) and perioperative blood transfusion (P = .02) were significantly associated with unplanned rehospitalization, according to the press release.

Moreover, higher postoperative day-1 glucose levels were associated with unplanned rehospitalization (P = .06), whereas ASA scores, sex, BMI, neoadjuvant therapy and postoperative pain scores were not.

These findings show that even in a high-volume specialist center, rehospitalization following esophagectomy is common, and identifying risk factors can help surgeons target patients before surgery to try to prevent readmission and complications, according to the press release. – by Adam Leitenberger

Reference:

Dickinson KJ, et al. “Unplanned Readmission Following Esophagectomy: Complete Follow-Up in a One-Year Cohort with Identification of Risk Factors.” Presented at: AATS Annual Meeting; May 14-18, 2016; Baltimore.

Disclosure s : Healio Gastroenterology was unable to confirm the researchers’ relevant financial disclosures at the time of publication.