Gomers go local.
The Study: If you think gomers don’t die, you’re just not seeing it. That may be because a lot of cancer patients travel a long way to get the best cancer surgery they can find...right before never coming back again. Putting this in the context of the ACA’s reimbursement penalties for readmission, this study queried the National Readmission Database to evaluate 90-day post-op courses for >60K cancer patients. Overall, 23% of patients were readmitted, and one in five of these were to a hospital different than the one where her surgery was performed. As you may have guessed, living in a small county (OR 1.75) and being discharged to a facility other than home (OR 1.2) were associated with higher odds of readmission to a different hospital, while the highest versus lowest income bracket was associated with lower odds (OR 0.73). Why do we care? Because the patients readmitted to a different hospital had a “significantly” higher mortality rate (5%) than those readmitted to the index hospital (3.6%), which really may be significant considering the numbers we’re dealing with here.
Bottom Line: Readmission to a hospital other than the one where a cancer operation was performed is probably not ideal for the patient, so educate them and/or their accepting facilities about the importance of avoiding fragmentation of post-op cancer care. | Zafar, JAMA Surg 2018