Factors Associated With Readmission to Index vs. Non-Index Hospitals After Major Cancer Surgery

Area of Science:

• Oncology
• Health Services Research
• Surgical Outcomes

Background:

• Regional referral centers offer improved perioperative outcomes for cancer surgery.
• Vulnerable patients face access barriers to these specialized centers.
• Readmission patterns (index vs. non-index hospital) after referral center surgery are not well understood.

Purpose of the Study:

• To investigate factors influencing readmission to index versus non-index hospitals for cancer surgery patients.
• To compare these factors between referral and non-referral centers.
• To identify cancer types with distinct readmission patterns at referral centers.

Main Methods:

• Utilized Pennsylvania Cancer Registry and PHC4 data for patients undergoing major cancer surgery with 90-day readmission.
• Applied multivariable logistic regression to identify factors associated with index vs. non-index readmission.
• Included an interaction term for referral center status and cancer type.

Main Results:

• 8215 patients had 90-day readmissions; 78% returned to the index hospital.
• Older age, high Elixhauser comorbidity scores, and longer travel times were linked to lower odds of index readmission.
• No significant difference in index readmission odds between referral and non-referral centers overall, but lung cancer patients at referral centers had lower odds (OR=0.59).

Conclusions:

• Clinical complexity and travel burden influence readmission destination after cancer surgery.
• Lung cancer patients treated at referral centers may experience greater care fragmentation compared to other cancer types.
• Further research is needed to address care coordination for vulnerable populations at specialized cancer centers.