Hospital Readmission as a Poor Measure of Quality in Ovarian Cancer Surgery

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Abstract

OBJECTIVE:

To evaluate the role of 30-day readmission rate as a quality of care metric in patients undergoing ovarian cancer surgery.

METHODS:

We performed a retrospective cohort study of women diagnosed between 2004 and 2013 with advanced-stage, high-grade, serous carcinoma who underwent primary treatment. Using the National Cancer Database, we compared the performance of hospital risk-adjusted 30-day readmission rate to other quality of care metrics (risk-adjusted 30- and 90-day mortality, rates of adherence to guideline-based care, and overall survival) within hospitals categorized by yearly case volume (10 or less, 11–20, 21–30, and 31 cases per year or more).

RESULTS:

A total of 42,931 patients met the inclusion criteria. The overall unplanned 30-day readmission rate was 6.36% (95% CI 6.13–6.59). After adjusting for comorbidity, stage, histology, and sociodemographic and treatment factors, hospitals performing 31 cases per year or more had a 24% higher likelihood of readmission (adjusted odds ratio [OR] 1.25, 95% CI 1.06–1.46) when compared with those performing 10 cases per year or less. However, hospitals performing 31 cases per year or more had a significantly lower risk-adjusted 90-day mortality (adjusted OR 0.74, 95% CI 0.60–0.91) despite higher rates of complex surgical procedures and higher rates of guideline-concordant care delivery (86% vs 77%, P<.001). In the Cox proportional hazards regression model, care at a high-volume hospital was independently predictive of lower hazard of death (adjusted hazard ratio 0.86, 95% CI 0.82–0.90).

CONCLUSION:

Hospitals with 31 cases per year or more have a lower 30- and 90-day mortality despite performing more complex surgeries, are more likely to be adherent to guideline-based care, and achieved higher overall survival.

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