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Does 30-Day Readmission Affect Long-term Outcome Among Glioblastoma Patients?

Nuño, Miriam PhD; Ly, Diana MPH; Ortega, Alicia BS; Sarmiento, J. Manuel BA; Mukherjee, Debraj MD, MPH; Black, Keith L. MD; Patil, Chirag G. MD, MS

doi: 10.1227/NEU.0000000000000243
Research-Human-Clinical Studies: Editor's Choice
Editor's Choice

BACKGROUND: Research on readmissions has focused mainly on the economic and resource burden it places on hospitals.

OBJECTIVE: To evaluate the effect of 30-day readmission on overall survival among newly diagnosed glioblastoma multiforme (GBM) patients.

METHODS: A nationwide cohort of GBM patients diagnosed between 1991 and 2007 was studied using the Surveillance, Epidemiology and End Results Medicare database. Multivariate models were used to determine factors associated with readmission and overall survival. Odds ratio, hazard ratio, 95% confidence interval, and P values were reported. Complete case and multiple imputation analyses were performed.

RESULTS: Among the 2774 newly diagnosed GBM patients undergoing surgery at 442 hospitals nationwide, 437 (15.8%) were readmitted within 30 days of the index hospitalization. Although 63% of readmitted patients returned to the index hospital where surgery was performed, a significant portion (37%) were readmitted to nonindex hospitals. The median overall survival for readmitted patients (6.0 months) was significantly shorter than for nonreadmitted (7.6 months; P < .001). In a confounder-adjusted imputed model, 30-day readmission increased the hazard of mortality by 30% (hazard ratio, 1.3; P < .001). Neurological symptoms (30.2%), thromboembolic complications (19.7%), and infections (17.6%) were the leading reasons for readmission.

CONCLUSION: Prior studies that have reported only the readmissions back to index hospitals are likely underestimating the true 30-day readmission rate. GBM patients who were readmitted within 30 days had significantly shorter survival than nonreadmitted patients. Future studies that attempt to decrease readmissions and evaluate the impact of reducing readmissions on patient outcomes are needed.

ABBREVIATIONS: CI, confidence interval

GBM, glioblastoma multiforme

ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification

SEER, Surveillance, Epidemiology and End Results

Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California

Correspondence: Chirag G. Patil, MD, MS, Center for Neurosurgical Outcomes Research, Department of Neurosurgery, Cedars-Sinai Medical Center Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd., Suite A6229, Los Angeles, CA 90048. E-mail: chirag.patil@cshs.org

* These authors have contributed equally to this article.

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Received June 12, 2013

Accepted October 28, 2013

Copyright © by the Congress of Neurological Surgeons