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

While receipt of surgery at regional referral centers is associated with improved perioperative outcomes, many vulnerable patients may experience barriers in accessing these hospitals. When these patients do manage to undergo surgery at referral centers, it remains unclear where they are readmitted to receive care when complications arise. Patients may be readmitted to the hospital where surgery was performed (index readmission) or to a different hospital (non-index readmission). This study examined whether factors associated with readmission to index versus non-index hospitals differ for patients undergoing surgery at referral centers compared to non-referral centers.

We used data from the Pennsylvania Cancer Registry and the Pennsylvania Health Care Cost Containment Council (PHC4) to identify patients who had major cancer surgery and were subsequently readmitted within 90 days. We fit a multivariable logistic regression model to identify factors associated with 90 day readmission to an index versus non-index hospital. We included an interaction term between referral center status and cancer type in this model.

A total of 8215 patients were readmitted within 90 days of cancer surgery, of whom 78% (N = 6388) were readmitted to the index hospital. On multivariable analysis, factors associated with lower odds of index versus non-index readmission included older age, high Elixhauser comorbidity scores, and longer travel times. There was no significant difference in odds of index readmission when patients were treated at referral versus non-referral centers (OR = 0.77; 95% CI, 0.50-1.20). When assessing interactions, patients with lung cancer had lower odds of index readmission when treated at referral versus non-referral centers, relative to other cancers (OR = 0.59; 95% CI, 0.41-0.84).

Higher clinical complexity and greater travel burdens were associated with lower odds of index readmission. Relative to other cancers, patients with lung cancer may be more likely to experience care fragmentation after undergoing surgery at a referral center.