Readmission within 30 days has been used as a metric for quality of care received at hospitals for certain diagnoses. In the era of accountability, value-based care, and increasing cancer costs, policymakers are looking into cancer readmissions as well. We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare claims data. We included elderly Texas residents diagnosed with GI cancer and identified risk factors for unplanned readmission using generalized estimating equations, comparing medical with surgical cancer-related hospitalizations.
We analyzed 69,693 hospitalizations from 31,736 patients. The unplanned readmission rate was higher after medical hospitalizations than after surgical hospitalizations (21.6% v 13.4%, respectively). Shared risk factors for readmission after medical and surgical hospitalizations included advanced disease stage, high comorbidity index, and emergency room visit and radiation therapy within 30 days before index hospitalization. Readmissions within 30 days of discharge are regarded by policy makers as failure of the transition of care process. Since 2009, the Centers for Medicare and Medicaid Services (CMS) has mandated the reporting of hospital-level readmission rates for diagnoses such as acute myocardial infarction and pneumonia. Under the Affordable Care Act (ACA), penalties are now being incurred by hospitals with high readmission rates for these encounters.
Unplanned readmissions among elderly patients with GI cancer are more common after medical hospitalizations compared with surgical hospitalizations.