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

Uppal, Shitanshu, MBBS; Spencer, Ryan J., MD; Rice, Laurel W., MD; del Carmen, Marcela G., MD, MPH; Reynolds, R. Kevin, MD; Griggs, Jennifer J., MD, MPH

doi: 10.1097/AOG.0000000000002693
Contents: Gynecologic Oncology: Original Research

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.

Despite a lower postoperative mortality rate, higher adherence to guideline-based care, and improved overall survival, high-volume hospitals have a higher readmission rate in ovarian cancer.

Division of Gynecologic Oncology, the Institute for Healthcare Policy and Innovation, the Department of Medicine, Division of Hematology Oncology, and the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan; the Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Division of Gynecologic Oncology, University of Wisconsin, Madison, Wisconsin.

Corresponding author: Shitanshu Uppal, MBBS, University of Michigan, 1500 E Medical Drive, Ann Arbor, MI 48109; email: uppal@med.umich.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the Society of Gynecologic Oncology's Annual Meeting on Women's Cancer, March 12–15, 2017, National Harbor, Maryland.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received February 5, 2018. Received in revised form April 7, 2018. Accepted April 12, 2018.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.