Predictors and Cost of Readmissions at an Academic Head and Neck Cancer Service

Abstract

Objectives:

With healthcare reform nationally debated, surgeons are increasingly called upon to improve quality of care while lowering cost of delivery. Rate of hospital readmission within thirty days of discharge (RA30) is a quality measure monitored by CMS and will subject healthcare systems to fines if they fall outside of acceptable standards. Unfortunately, few benchmarks in head and neck surgery (HNS) exist. Our goal was to determine: 1) the rate and predictors of readmissions, and 2) a detailed cost breakdown of readmissions on an academic head and neck surgery service.

Methods:

A prospective-cohort study at a tertiary-care academic center was conducted. Six hundred and ninety-four patients from 2011-2012 underwent HNS procedures. Demographic, pathological, and follow-up data were collected. Financial information for each admission was obtained from the hospital billing database. RA30 was the primary outcome. Multivariate analysis identified peri-admission factors predictive of re-admission. A cost analysis was performed.

Results:

C4QI cancer hospital-readmission benchmarks for fiscal year 2011 were 17.29%. On the HNS service, 39 (5.6%) patients were re-admitted to the hospital. Thirty-six of 39 patients were admitted due to wound complications and 3/39 due to pneumonia (2) or C difficile (1) colitis. Predictors of re-admission were age >65 years, advanced stage cancer, previous radiation therapy, multiple medical comorbidities, and high-acuity procedures (P < 0.05). Median cost of readmission was $20,877.84 (range: $3,201.50-$174,693.30). The highest source of readmission cost was the operating room.

Conclusions:

Readmission rates on a busy HNS service can be low, but costly. Knowing factors predictive of readmission may help create preventative and minimize excess costs.