Hospital readmission after ovarian cancer surgery: Are we measuring surgical quality?

Emma L. Barber*, Kemi M. Doll, Paola A. Gehrig

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Objectives Readmission after surgery is a quality metric hypothesized to reflect the quality of care in the index hospitalization. We examined the link between readmissions and a surrogate of surgical quality – major postoperative complication – among ovarian cancer patients. Methods Patients who underwent surgery for ovarian cancer between 2012 and 2013 were identified from the National Surgical Quality Improvement Project (NSQIP). Major complications were defined as grade 3 or ≥ complications on the validated Claviden-Dindo scale and included both NSQIP and non-NSQIP defined complications based on readmission ICD-9 code. Readmissions and complications within 30-days of surgery were analyzed using rate ratios and modified Poisson regression. Results We identified 2806 ovarian cancer patients of whom 9.1% (n = 259) experienced an unplanned readmission. Overall major complication rate was 10.9% (n = 307). Major complications in the index hospitalization were not associated with subsequent readmission (RR 1.2, 95% CI 0.7–1.9). Overall, 41.4% of readmissions were not attributable to any major postoperative complication. Of the unplanned readmissions, 55.2% (n = 143) never experienced a NSQIP-defined major complication. Of these 143 patients, the reason for readmission was known for 107 patients and was: 28.0% non-NSQIP-defined major complications; 16.8% cancer or other medical factors; 22.4% minor complications; and 32.7% symptoms without a diagnosis of complication. Conclusions Forty percent of unplanned readmissions after ovarian cancer surgery occur among patients who have not experienced a major postoperative complication. Quality metric benchmarks and efforts to decrease readmissions should account for this high percentage of readmissions not associated with a major complication.

Original languageEnglish (US)
Pages (from-to)368-372
Number of pages5
JournalGynecologic oncology
Volume146
Issue number2
DOIs
StatePublished - Aug 2017

Keywords

  • Ovarian cancer
  • Postoperative complication
  • Postoperative readmission
  • Surgical quality

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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