Postoperative Complications Drive Unplanned Readmissions After Esophagectomy for Cancer

Background. Hospital readmissions are increasingly viewed as a marker of inferior health care quality and penalized with decreased reimbursement. The timing of, and reasons for, readmissions after esophagectomy for cancer are not well understood. We examined the association of complications to 30-day postoperative-related, unplanned readmission to identify opportunities for improvement in patient care. Methods. We analyzed the American College of Surgeons National Surgical Quality Improvement Program database (2012 to 2015) to characterize 30-day postoperative unplanned readmissions after esophagectomy for cancer using descriptive statistics. Type and timing of readmission after discharge was assessed. A Cox proportional hazards model was developed to identify predictors of readmission. Results. Of 3,723 patients who underwent esophagectomy for cancer, 1,419 (38.1%) experienced >= 1 complication within 30 days. A total of 400 patients (10.7%) experienced related, unplanned readmissions within 30 days of the operation, and postoperative complications were documented in 263 (65.8%). Leading causes of readmission were infectious, pulmonary, and gastrointestinal complications. Of these patients, 155 (59%) were readmitted within 7 days and 236 (90%) within 14 days of discharge. The Cox proportional hazards model identified readmission being associated with occurrence of postdischarge infectious, pulmonary, venous thromboembolic, and urinary tract infection complications, in-hospital urinary tract infection complications, and log-transformation of length of stay (representing increasing length of stay) (all p < 0.05). Conclusions. Postoperative occurrence of common complications and prolonged length of stay are associated with unplanned readmission after esophagectomy. Most patients are readmitted within 1 week of discharge. Earlier follow-up after discharge may identify patients with complications and facilitate outpatient intervention to prevent readmission. (C) 2018 by The Society of Thoracic Surgeons