THE ASSOCIATION BETWEEN HOSPITAL CHARACTERISTICS AND READMISSION FOR ENDOMETRIAL CANCER PATIENTS UNDERGOING SURGERY IN THE US

OBJECTIVES: To analyze whether patient and hospital characteristics are associated with all-cause readmissions among endometrial cancer patients undergoing surgery. METHODS: The 2013 Nationwide Readmission Database (NRD) was used. The NRD, managed by the Agency for Healthcare Research and Quality, includes readmissions for both insured (commercial vs. government) and uninsured patients in the U.S., and is designed to produce readmission rates at the national level. The study population consisted of hospitalized patients undergoing surgery for non-metastatic endometrial cancer. Surgeries considered were vaginal, laparoscopic or roboticassisted hysterectomy (minimally invasive) as well as open hysterectomy. Outcomes analyzed were 30-day, 60-day, and 90-day all-cause readmissions. For each outcome the study cohort was restricted to patients having an index hospitalization in 2013 while ensuring that the study patients also had enough time for the respective outcome. Multivariate logistic regression was performed to assess factors associated with hospital readmission rates. RESULTS: The 30-day, 60-day and 90-day cohorts included 23,006, 21,071 and 18,885 patients, respectively. Factors associated with hospital readmission rates were: type of surgery, patient age, comorbidity count, hospital teaching status, and hospital urban-rural designation. The following were common across the three readmission outcomes studied: 1) open surgery had approximately two times the odds of readmission compared to minimally invasive surgeries (Odds ratio or OR for 30-day outcome: 2.073, 95%CI: 1.738 -2.473); and 2) metropolitan non-teaching hospitals had approximately 26% less odds of readmission compared to metropolitan teaching hospitals (30-day OR: 0.741, 95%CI: 0.603-0.910). Furthermore, for 60-day and 90-day readmissions, small metropolitan hospitals had approximately 20% less odds of readmission compared to large metropolitan hospitals (e.g., 60-day OR: 0.789, 95%CI: 0.669-0.932). CONCLUSIONS: Surgical type, hospital teaching status, and hospital urban-rural designation were associated with differing all-cause readmission rates. More research is warranted to understand why and how these factors may be associated with readmission outcomes.