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Back to 2014 Annual Meeting Abstracts
Readmissions After Esophageal Resections
Abhishek Sundaram*1, Ananth Srinivasan1, Sarah Baker2, Sumeet K. Mittal1
1Surgery, Creighton University, Omaha, NE; 2ICU nursing, Creighton University, Omaha, NE
Background: There has been an increasing emphasis on readmission, both from a quality of care and a cost perspective. Esophagectomy for esophageal cancer is one of the more morbid surgical procedures. However, limited reports exist on risk factors associated with readmission after esophagectomy.
Objective: Determine the 30-day readmission rate after esophagectomy for esophageal cancer and risk factors associated with readmission.
Methods: Retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) 2011-12 database was performed to identify patients who underwent elective esophagectomy for esophageal cancer.
Results: One thousand one hundred and three patients satisfied study criteria. One hundred and thirty seven patients (12.4%) were readmitted within 30 days of surgery. Readmitted patients were significantly older (mean age: 65.9 years vs. 63.8 years, p=0.02) and had a higher proportion of males (91.2% vs. 83.2%, p=0.01) than patients who were not readmitted. There was no significant difference between the groups in terms of other peri-operative variables like cardiac disease, neo-adjuvant therapy (chemotherapy within 30 days and radiation within 90 days of surgery), type of esophagectomy performed and body mass index. Readmitted patients had a higher incidence of superficial surgical site infections (SSI) (13.1% vs. 4.9%, p<0.001), deep incisional SSI (8% vs. 1.8%, p<0.001), organ space infections (12.4% vs. 5.5%, p=0.002), sepsis (21.2% vs. 11.3%, p=0.001) and venous thromboembolism (11.7% vs. 3.9%, p<0.001). Readmitted patients had a significantly shorter mean length of index hospital stay (11.25 vs. 14.75 days, p<0.001). On multivariate logistic regression analysis, significant risk factors for 30 day readmission were: male gender, history of pulmonary disease, diabetes mellitus (DM), hypertension (HTN), postoperative wound complications, sepsis and shorter hospital stay. Patients who were readmitted had a significantly higher incidence of the following post discharge complications: SSI (7.3% vs. 1%, p<0.001), deep incisional SSI (3.6% vs. 0.4%, p<0.001), organ space infections (5.1% vs. 1.9%, p=0.05), pneumonia (7.3% vs. 2.1%, p=0.001) and venous thromboembolism (2.9% vs. 0.8%, p=0.02).
Conclusions: Readmission rate after esophagectomy for esophageal cancer is around 12.4%. Patients, who are male, have co-morbid conditions like DM, HTN and pulmonary disease are at higher risk for readmission. Earlier discharge is not always ideal as it comes at the cost of a higher readmission rate. Emphasis should be placed on optimizing modifiable peri-operative factors namely, comorbid conditions, tissue handling, wound care and pulmonary toilet as a means to reduce readmission.
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